This graduation project focused on strengthening the blended cardiac rehabilitation pathway at Basalt Leiden by exploring how activity tracker data from The Box, a home-monitoring initiative developed by LUMC for cardiac patients, could be meaningfully integrated into daily practice. Basalt’s assignment was to identify possible bottlenecks in the integration of this data and, based on the identified insights and opportunities, a tool is designed that supports its implementation. Integrating step count data is important because it can provide physiotherapists with more objective insight into patients’ daily physical activity. Currently, remote coaching moments largely depend on patients’ self-reported activity, while Basalt aims to make rehabilitation more data-informed, personalised, and supportive of long-term behaviour change.

The project followed the Double Diamond process, moving from broad exploration towards a focused design proposal. A literature review was conducted on cardiac rehabilitation, blended care, hybrid care, technology adoption, and behaviour change. This was complemented by context research at Basalt, including semi-structured interviews, stakeholder walk-alongs, stakeholder mapping, thematic analysis, and journey mapping. Insights were gathered from patients, physiotherapists, other healthcare professionals, organisational stakeholders, and researchers to understand the current pathway, stakeholder needs, and barriers to implementation.
The research showed that blended care is already present at Basalt, especially within physiotherapy through physical training, home exercises via Physitrack, and evaluation phone calls. However, it is not yet clearly defined, consistently introduced, or structurally embedded in daily practice. Patients are not
always sufficiently onboarded, which contributes to limited engagement with digital tools. Physiotherapists also differ in how they apply blended care, partly due to the absence of a shared workflow. In addition, the findings showed that remote coaching currently relies strongly on subjective self-report. This supported Basalt’s existing ambition to integrate activity tracker data into the pathway, as step count data could provide physiotherapists with more objective insight into patients’ daily physical activity. However, the findings also showed that this data will only be useful if it supports coaching in a practical way and does not create extra workload.

Based on these insights, the design direction shifted towards supporting Basalt’s organisational team in onboarding physiotherapists to the use of activity tracker data. The final concept, Steps2Coach, consists of a physical pathway cube and a supporting poster. The cube visualises six phases of the physiotherapy trajectory: physio intake, physical treatment, home training, evaluation preparation, evaluation phone call, and aftercare. Each side explains the patient milestone, the physiotherapist’s role, the added value of activity tracker data, and a coaching prompt. The poster provides additional context about The Box and practical support. Together, these elements make activity tracker data visible, tangible, and connected to concrete coaching moments. Evaluation showed that Steps2Coach is clear, engaging, and relevant as a first step towards implementation, while further testing and practical integration are still needed.
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Lifestyle Medicine (LM) has demonstrated significant potential in reducing morbidity and mortality by addressing behavioural risk factors. However, its clinical application remains limited within the Dutch healthcare system, where clinicians face substantial barriers to integrating lifestyle counselling into routine practice. These challenges stem from time-constrained consultations (10-15 minutes) and inadequate systematic training in relevant skills and knowledge. Current training methods, including traditional workshops and online courses, lack either scalability or the ability to develop practical, hands-on competencies, creating an urgent need for innovative training solutions suitable for real-world hospital environments.

This graduation project, commissioned by Leiden University Medical Centre (LUMC), addressed the research question: "How can conversational agents be designed to train healthcare professionals in delivering lifestyle counselling within the 10–15 minute consultation time frame?" The study employed a comprehensive research methodology including literature review and two phases of user research to identify and reframe the core problem. The research revealed that the commonly cited "lack of time" barrier is actually a symptom of a deeper "professional capability gap," encompassing insufficient practical skills, low confidence, and inadequate LM awareness. Focused interviews with clinicians in hospitals further identified a "systemic support gap," characterised by a lack of structured workflows and integrated infrastructure.

Based on these findings, the study developed WellSaid, an AI-driven digital ecosystem designed to train and support clinicians in lifestyle counselling. The solution comprises three integrated components: Consultation Training featuring an AI conversational agent for role-play practice; a Lifestyle Toolkit providing practical resources and support materials; and a Library serving as a centralised hub for accessible, evidence-based information. Expert review by LUMC clinicians confirmed the prototype's desirability and conceptual feasibility, validating that AI-driven conversational training ecosystems can effectively address professional capability gaps. This project demonstrates that AI-based conversational training ecosystems can effectively equip healthcare professionals with practical skills, confidence, and systematic support necessary for integrating lifestyle counselling into routine hospital care, promoting broader LM adoption and supporting more preventive, patient-centered healthcare delivery.

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This thesis examines how self-experimentation can support health behavior change for young adults with ADHD. The work speaks to a gap in ADHD research that rarely addresses health promotion as a lived, day to day practice. The central question guiding the project is: What role might self-experimentation play in the health behavior change process of young adults with ADHD?

Methodologically, the project uses Research through Design with participatory methods to generate situated insight rather than a fixed solution. The study unfolds across four phases that move from context to concept, from interaction to impact. Activities include co-creation with ADHD participants, expert interviews, iterative prototyping, user testing, and reflective sessions. In Phase 1, three co-creation sessions engaged nine students with ADHD, complemented by interviews with five experts. Phase 2, is where ideation activities take place and a concept for SE for ADHD is developed. In Phase 3, a first self-experimentation toolkit was prototyped and tested over two weeks, followed by a group session. In Phase 4, a refined toolkit was tested for two weeks by seven participants, followed by one on one interviews.

Two design artefacts structure the inquiry. Prototype 1 introduced a friendly, low-barrier toolkit built around the idea of consistency over perfection, with two foldable journals, a map, and a compass to support planning, tracking, and reflection. Prototype 2 consolidated use into a single foldable journal with optional stickers and a digital guide, aiming to reduce fragmentation and make the two week journey visible and easier to sustain. Both prototypes follow a three-step self-experimentation cycle of Plan, Track, and Reflect adapted for ADHD.

Across phases, three contributions emerge. First, Phase 1 introduces Dropout States as a framing for moments when ADHD users are most likely to disengage. These tags capture recurrent pitfalls such as Overwhelm, Perfectionist, Negative, Low Stimulation, and Unaccountable, and help explain why well-intended plans fail. Second, a complementary set of Guiding Principles is articulated to counter these pitfalls, including Simplicity, Guidance, Positivity, Stimulation, Accountability, Visibility, Flexibility, and Sensemaking. Third, the project defines SE as a potential reframing tool for ADHD individuals. Together, these elements form a practical lens for designing tools that help people show up, learn, and adjust.

Findings show that self-experimentation can reframe the change process in useful ways. Participants described relief from perfection pressure, better organization of mental clutter, clearer translation of intentions into concrete actions, and more individualized strategies that fit current context. At the same time, the approach introduces frictions that matter in ADHD. Many participants relied on external accountability, reported cognitive effort at key steps such as planning and daily documentation, and found hybrid or purely physical formats hard to keep accessible in daily life. These insights position self-experimentation as a promising tool for initiating change and building self-knowledge, provided that tools include supportive structures and minimize effort.

The project proposes a Progressive Engagement Model as a way to align the method with ADHD needs. In this model, people begin with short, guided micro-experiments that are playful and low effort, then shift toward greater autonomy only as readiness and confidence grow. This direction sits alongside clear limitations of the study, including two-week trials, a sample of eleven ADHD participants and five experts across phases, heavy reliance on qualitative evidence, and the potential influence of researcher facilitation on engagement.

In sum, self-experimentation is not a single solution. It is a practical way to potentially reframe health behavior change for young adults with ADHD, making the process more forgiving, organized, actionable, and personally relevant, as long as design choices reduce cognitive load and bring in accountability where needed. Ultimately, this thesis contributes to a body of research that seeks to understand ADHD not only through deficits but through contextual and experiential knowledge. By investigating self-experimentation not as a fix, but as a reflective and adaptive process, the project highlights the value of designing with neurodiverse users. Breaking the cycle means more than disrupting habits, it means challenging assumptions about what change should look like.
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The healthcare sector is under pressure due to the aging population and a growing number of chronic musculoskeletal disorders, which are driving up healthcare demand. One of the key challenges within this system is the transition between hospital care to rehabilitation. This stage can be characterized by a lack of transparency, guidance and long waiting periods. Because of this, many people define it as a “black hole” in their care pathway. This project aims to improve this “black hole” period, with an emphasis on patients with joint complaints.

The goal of this graduation project is to improve the healthcare experience for patients with joint complaints from the initial hospital appointment to the the start of rehabilitation. Focusing on the context of Basalt rehabilitation and Reinier de Graaf Hospital.

Using a user-centered design approach supported by the Double Diamond model, the project involved extensive literature research, context mapping, interviews, and observational studies with both patients and healthcare professionals.

The patient interviews showed that patients gain valuable knowledge and skills, such as energy management and understanding of the pain system, during rehabilitation. While this information and tools could have helped many patients much earlier. Delayed access to such insights can lead to a lower quality of life.

These insights shaped the final design, the Pacewise app. This app is an useful tool meant to give patients a timely and easily way to better manage their energy levels before they require rehabilitation. ... Read more

With the European population rapidly aging, addressing the vulnerabilities associated with physical and cognitive decline is essential. Promoting an active lifestyle among older individuals has proven effective in preserving health and independence. Growing evidence suggests that combining cognitive and physical exercises can significantly enhance both cognitive function and physical health, especially among sedentary elderly populations who are at increased risk due to physical inactivity.

This thesis, conducted in collaboration with the Portuguese company Neuroinova, presents the development and evaluation of a digital intervention aimed at integrating physical exercises into their platform for cognitive training COGWEB in individuals experiencing cognitive decline or impairments. The integration process started with ACTIVAS, a program developed in collaboration with researchers from the University of Aveiro, who provided guidelines for an effective physical exercise regimen based on personalization and progression. However, motivating users to adhere to the program, particularly in a remote setting, remained a challenge.

Understanding the needs and barriers of both patients and professionals was crucial to shaping a program that positively impacts user motivation.
Utilizing a user-centered design approach, including generative sessions, interviews with healthcare professionals, and literature reviews, two primary user groups were identified: sedentary individuals with minimal physical activity and busy active individuals with irregular physical exercise patterns. Despite individual differences, the insights revealed that successful integration of physical exercises into COGWEB requires clear, structured guidance from a trusted professional, such as a physiotherapist, alongside engaging and enjoyable exercise activities. Personalization of the program emerged as a key factor in addressing these needs.

The design process focused on ensuring effective guidance and engagement by iteratively testing various prototypes of exercise sessions, with special attention to interaction qualities such as being engaged, guided, proud, trusting, and in control.
The final concept involved a session where cognitive tasks in the form of games—similar to the original COGWEB format—were paired with physical movements and exercises, allowing users to train both cognitive functions and their body simultaneously. Emphasis was placed on providing clear instructions and professional guidance through the presence of a physiotherapist.

Final test results showed promise in motivating sedentary individuals to participate in these sessions, achieving the design goal of ensuring guidance and engagement. While the design objective of this thesis was met within the study's scope, further work is necessary to implement and evaluate the program's long-term effectiveness in real-world settings. The findings suggest that this approach has the potential to significantly increase physical activity levels and improve adherence among elderly COGWEB users, contributing to their overall well-being. ... Read more

The aim of this Master’s thesis is to determine how user engagement and motivation can be improved when using the Athlete Management System (AMS) as a monitoring system. This system monitors athletes subjectively and objectively for short and long-term progress. Increased use of this monitoring system will result in a more complete and valuable data set for coaches to identify the risks of under- or overtraining for KNSB talented athletes in both long and shorttrack disciplines.

Several interviews were conducted with athletes, experts from the KNSB Talent Teams (KTTs), and other experts in the field of AMS, sports psychology,
and sports innovation centers. These interviews were used to explore how the target group reflected on their sports’ progression and how the feedback process from the KTT staff played a role in this, supported by a literature review of related topics in the context of the project aim.

After interviews with athletes, coaches, and embedded scientists, potential design directions were identified and one was selected by evaluating the directions for feasibility and impact concerning the project aim. The chosen design opportunity is to improve communication about AMS between athletes and their coaches and to provide more guidance in an athlete’s reflective process when they need to measure their recovery-stress state of ‘Mental Readiness’ in AMS, which can be described as the athlete’s ability to concentrate on the execution of a training session. Measuring the recovery-stress state of an athlete can help identify the risk of under- or overtraining. Athletes and coaches experience difficulties interpreting and assessing ‘Mental Readiness’.

Brainstorming and concept validation sessions are conducted to develop a final design: a workshop session consisting of a presentation with three assignments to allow athletes and their coach to share their interpretations of the ‘Mental Readiness’ scale and to give first steps of guidance on how to reflect as an athlete on this scale. The final design is an addition to the kick-off meeting at the beginning of the speed skating season. It also proposes a roadmap for the long-term implementation of the final design in the context of the target group, including additional suggestions for other workshops and presentations to improve communication and behavior around AMS based on the insights from the interviews.

Further research should investigate how the final design leads to behavioral changes in user engagement and motivation in long-term implementation.
In addition, other aspects of the recovery-stress state, such as ‘emotional state’ and ‘motivation’, could be explored to broaden the communication and enhance the self-reflection of the athlete. In future research, it is important to expand guidance for athletes in their reflective capacity and for KTT staff in the correct interpretation and next steps when receiving ‘Mental Readiness’ data. This will help to motivate athletes to work with the final design and increase user engagement with the Athlete Management System. ... Read more

This project introduces “Ledemaatje,” an interactive product designed to help older adults with mild intellectual disabilities (ID) stay active in a fun, independent way. Physical activity (PA) is essential for one’s well-being, yet barriers like caregiver dependence and limited access often stand in the way for people with ID. Ledemaatje aims to change that by offering a low-barrier, engaging solution that encourages movement and social connection. Developed through participatory design, this project focused on creating an accessible and motivating experience shaped by direct user feedback at every stage.

Research into the context of living with ID and current PA interventions shaped the project’s design goals and criteria, emphasizing autonomy, accessibility, and social engagement. The development phase involved multiple interactive sessions with three older adults with mild ID, living at a residency at the organization ‘s Heeren Loo. Observations and feedback gathered during each session were leading for the design direction of this project. These sessions revealed that performing activities in a group setting were effective in prompting PA but there was still a dependency on external motivation. Further testing focused on understanding user responses to different stimuli, and levels of autonomy,

Ledemaatje’s final design enables semi-autonomous use, allowing residents to interact with the product in a group setting while requiring minimal caregiver support. Ledemaatje uses automated movements, to prompt users to push, pull, and engage with the device, promoting upper-body movements not typically used in daily activities. These interactions are further enriched by sound cues, such as applause, rewarding users and providing a positive interaction experience.

Evaluations with residents and caregiver in a typical residential setting showed that Ledemaatje effectively promotes PA and social interaction. While participants’ motivation varied depending on the task speed and complexity, feedback highlighted the product’s support for resident autonomy and engagement.

In conclusion, Ledemaatje demonstrates the value of user-centered design, providing a low-barrier, enjoyable PA option. Recommendations include refining the product’s automated features to further minimize caregiver involvement and adding adjustable settings to better suit individual capabilities. This project contributes to the development of inclusive, affordable PA interventions for individuals with ID, fostering a more active environment in care facilities. ... Read more

The impact of socioeconomic position (SEP) on health in our society is evident. Chronic illnesses disproportionately affect individuals with low SEP, exacerbating the healthcare burden for both themselves and society at large. While a healthy lifestyle is crucial for disease prevention, engagement in this behavior is often limited within these groups. eHealth interventions, which could help these individuals adopt healthier lifestyles, typically follow a one-size-fits-all approach that favors higher SEP individuals, inadvertently widening the health gap. To address this issue, this dissertation presents the Inclusive eHealth Guide (IeG), a comprehensive tool developed through participatory methods to tailor eHealth interventions to the specific needs, skills, and preferences of low SEP individuals. The dissertation is organized into three parts.

Part A investigates the attitudes of low SEP individuals toward health, healthcare, and eHealth, revealing diverse needs that challenge the stereotype of unwillingness to engage in health-promoting activities and highlighting the potential of participatory design to meet these needs. Part B details the development of the IeG, synthesizing bottom-up insights from community engagement with top-down professional perspectives to create a practical resource for equitable eHealth design. Part C illustrates the application of the IeG in developing a tailored eHealth intervention for patients with low SEP in cardiac rehabilitation.

Ultimately, this work contributes to narrowing the health gap by identifying different SEP subgroups that require distinct approaches. Furthermore, the IeG serves as a practical tool to help eHealth professionals align their interventions with the needs of the target group. Finally, we outline key implications for the successful design of equitable eHealth solutions in the future.
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The rheumatology department of ErasmusMC wants to improve the effectiveness of their future Psoriatic arthritis and Rheumatoid arthritis care paths. The expected lack of capacity on the department asks to solve this problem in a capacity-efficient way. Including remote monitoring in the care path and shifting towards a self-management approach, where the patient takes an active role in their care path, create opportunities for this. Currently, patients with a lower socioeconomic position are associated with limited health skills and lower disease outcomes than patients with a higher socioeconomic position. When designing a support approach that asks for more self-reliance of the patients, it is important to take this patient group’s specific characteristics and needs into account to prevent the gap in disease outcomes from increasing further.

This thesis project aims to find out what the future hospital self-management support should look like to better support patients with a lower socioeconomic position in self-managing their disease and what opportunities the remote monitoring intervention that ErasmusMC is currently designing could provide in this

A user-centered design approach was used to define and solve this complex problem were both stakeholders, including the patients as well as the healthcare workers, were included during both the research and the deisgn phase of the project.

Research revealed that in the current situation, a lacking communication about the topic of self-management between healthcare workers and patient causes the patient to start off their self-management journey with an insufficient knowledge base, negatively influencing their ability and motivation to take an active self-management role. Along their journey, patients’ issues in developing an understanding of the personal disease manifestations and thinking in a solution-oriented way decreases this ability and motivation further.

Through co-creation with the stakeholders a future support approach was designed, consisting of a communication approach and a home support app. The support approach focuses on establishing a clear, consistent and engaging way of communicating about the topic of self-management between healthcare workers and patients and guiding and engaging the patient in developing an understanding of their disease and its management.

Evaluation showed that the support approach increases the patient’s ability and motivation to take an active self-management role and provides healthcare workers a structure that supports them in obtaining input from their patients and conveying self-management information in a clear and engaging way. The benefits the support approach could establish regarding patient’s health outcomes and self-reliance seem to outweigh the resources needed to establish this. Enabling connection with future remote monitoring interventions would positively influence the viability of the concept further. Further evaluation is needed to validate the actual effect of the support approach on the longer term.

The insights gained during this project about defining and modeling self-management, communicating about self-management and the characteristics and pains of patients with a low socioeconomic position show opportunities for future research and potential for generalization over the broader health domain. ... Read more

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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It is difficult for people to find strategies that fit their needs for changing behaviors. This project investigates how individuals can be supported to reflect on their health behaviors through the use of technology. Through various research and design methods, the project provides a comprehensive overview of the literature on reflections, how technology can support them, how they can assist in the behavior change process, and how to design for reflections. The identification of nine core reflection needs and the creation of a design space lead to a design concept and a prototype. The project reveals that helping people to reflect is a promising approach to helping them change behaviors. There are many ways to design for reflection, and the Reflection Card created in this project successfully helps people to do so. Reflections not only lead to self-insights, but they are also desirable due to their inherent qualities of slowness, deliberateness, and inefficiency. In a world designed around efficiency and speed, it is a refreshing approach to support people in their behavior change process. ... Read more

We all want to keep balance in our lives, however, we don’t live statically, changes in our daily environments are inevitable and the need to know how to restore balance when faced with external stimuli is a lifetime effort.

The long-term effects of stress, both physical and psychological, are of increasing concern with some even arguing that they constitute a health crisis. People often rely on their set of abilities and experience to solve this crisis, even so, there are many existing stress management techniques designed and tested to efficiently solve the most common sources of stress.

But if effective stress management solutions exist, why do we find more people with anxiety, depression, and other health conditions which are known to be associated with prolonged periods of stress?.

An intervention is proposed within this project, utilizing design methodologies and Self-Experimentation, that helps people enhance their stress abilities and Coping Behavior for their particular needs and life situations. ... Read more

Psoriatic arthritis is a chronic inflammation disease that affects the joints and the skin, which can manifest in many ways and various severities. Psoriatic arthritis impacts the lives of patients in both physical and mental ways. This project focussed on how the patient experience can be improved of newly diagnosed psoriatic arthritis patients. The patient experience involves multiple things, including the hospital visits and life at home. For this project it was decided to focus on the context of home. To get the necessary insights into the disease and the experience of patients with psoriatic arthritis, the co-creation method was used. In this method, a small group of stakeholders are actively part of the complete project as experts. In this project, five PsA patients were included as experts of their own experiences. The literature study and explorative research done in this project showed the following thing about the patient experience of PsA patients:

- Most of the information and help that is available focusses on the physical difficulties that psoriatic arthritis causes, even though there are a lot of mental difficulties that currently get too little attention.

- There is a lot of information available that the patients only get when they look for it themselves. But especially right after their diagnosis, they have little to no idea of what is relevant and what they have to look for.



With this knowledge, it was decided to focus on these mental difficulties that patients have. To do this, several group sessions together with the five participating patients were done. These sessions revealed that the diagnosis of psoriatic arthritis influences the perception of their identity as well as how they think others perceive them. The patients want to stay valuable and independent, where the psoriatic arthritis causes them to make changes in their daily life and become more dependable. This gives patients the idea that the psoriatic arthritis sometimes takes control over their life. This insight led to the design goal of the project, where the focus laid on empowering the patients to be in control of their own life again.



Together with the participant group, various design directions were explored and evaluated with help of various prototypes. This eventually resulted in the final design: The PEPSA journal.



The PEPSA journal is a service that provides the user with journal pages that focus on several aspects of life and psoriatic arthritis. The journal makes a distinction between standard material, which is relevant for everyone and focus topics, which allow the user to personalize their journal and make it more fitting to their life and what they think is relevant. Through positively formulated questions about each topic the users are encouraged to think about the various aspects of their life and psoriatic arthritis and how they relate to and influence each other. In this way the PEPSA journal allows the user to get more insights into their situation and get a clearer view of their life with psoriatic arthritis, putting them back in control.

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Since 1975, obesity has nearly tripled globally, indicating a clear trend that threatens public health. Besides changing one’s diet, the illness can be prevented by performing sufficient physical activity. In the Netherlands however, currently only 20% of the children of 11 years old meet the World Health Organisation guidelines for physical activity (Volksgezondheidenzorg.info, 2020). This is worrisome, since habits of sedentary behaviour often stick with a person from youth to adulthood (Hirvensalo & Lintunen, 2018). (World Health Organisation, 2021)

The section Child and Adolescent Public Health Research & Innovation (CAPHRI) of the Amsterdam University Medical Centre commissioned this project to address the lack of physical activity of children in Amsterdam. This project specifically targets the Dapperplein, as the section identified an interesting opportunity space here: During the day it is occupied by its daily market, but in the evening, when the market is cleared, an open space is revealed. This project aims to find ways to use that open space, and design something that stimulates children’s physical activity at the Dapperplein, after market hours.

In order to do so, children living near the Dapperplein were engaged in co-creation. Co-creation with children has the potential to create a design that fits the users’ (children’s) needs, because it creates understanding of their context for the designer (me), via close involvement and collaboration of the user and designer in the design process. The children act as co-designers. During workshops with these children, as well as expert interviews, observations and a literature study the context of the Dapperplein was explored and problems were revealed. As the project discovered, the children (and their parents) do not consider the Dapperplein to be safe during the evening. This is due to people hanging out and drinking at the square, as well as traffic that crosses at speed. Additionally, a lack of hygiene because of market leftovers is identified. Lastly, there are few stimuli present for children to play.

To address these problems, the design of “De Klimkramen’’ was created. It proposes to place playing equipment at the Dapperplein that during the day, with addition of an awning and board, functions as market stalls. This creates a safe playing area, as it forms a physical barrier for traffic, and since it is inviting towards residents, more people will be there to keep an eye out. A sense of community is fostered as it is used in harmony with the market and forms an iconic view for the Dapperplein.

During an evaluation, the design was well received by representatives of the market, police and fire brigade, although adjustments are needed to ensure a better fit with the needs of the market vendors, and to avoid creating a new spot for people to hang out and consume alcohol.

Besides contributing to the section CAPHRI and to involved stakeholders with the design of “De Klimkramen”, this project contributes to the design field with a reflection on the application of co-creation with children, and practical tips for those who (will) apply the method. ... Read more

Regular physical activity helps to improve the health, fitness and quality of life of people, and prevent or decline aging related health issues. The amount of physical activity in older adults with an intellectual disability is extremely low. Contextual research indicates that this physical inactivity stems, among other things, from previous negative experiences, the habit of being inactive, limitations related to the cognitive and physical disability, and interventions that are not taking into account these limitations. These barriers emphasize the client’s dependence on an external incentive to become physically active, but caregivers of the clients lack time to provide this stimulus. Along with an increased life expectancy of people with an intellectual disability, this increases the need for a physical activity intervention that suits the individual abilities and interests of the clients, while asking minimal time from the caregivers.

Many interventions that have been created for stimulating physical activity in people with an ID, are either not adapted to people of an older age, or not created in (creative) collaboration with the older adults. This project is therefore carried out in close collaboration with six older adults with an intellectual disability, and their caregivers.

Literature and context research showed the current barriers and motivators towards physical activity, from the perspective of the clients, the caregivers, and the physiotherapist in this context. A research through design approach, consisting of creative sessions together with clients, caregivers, and other experts, resulted in a design that is adapted and adaptable to the diverse group of older adults. The design intervention proposed in this project is called the ‘MakiMove’.

The MakiMove is a large, vertical game board that offers fun and active activities to older adults with intellectual disabilities. The product provides a positive experience to the older adults, and simultaneously increases their physical activity. The variety of activities and difficulty levels make the design adaptable to the abilities and interest of the individual client.

Although the MakiMove allows the client to move without much assistance, it is not possible to interact with the concept completely independent of a caregiver or other supervisor. With social contact and encouragement being valuable facilitators for the client, it is questioned whether independent physical activity is the road to take. On this basis, it is recommended to look into how to enable caregivers or other supervisors to play a role in increasing the physical activity of the older adults.

To create a successful experience, it is important to adapt a design to the client’s abilities and interests. To get to know the clients well, they should be involved in the design process. The experiences in this project have led to guidelines for collaborating with the target group, aiming to inspire future researchers and designers to involve this increasing population of older adults with an intellectual disability in their projects.
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People with diabetes often show symptoms heavily associated with depression, but these symptoms are often caused by the burden of daily diabetes management. The negative feelings caused by this burden are defined as "diabetes burnout''. Some of these negative feelings are caused by social issues. People with diabetes often resort to online sources to find out how to deal with these social issues since health care providers do not focus on this side of diabetes. Furthermore, the social stigma surrounding treatment for mental problems stops people with diabetes from going to a psychologist. In this project, a conversational agent is designed, implemented and evaluated to investigate whether it is capable of reducing social diabetes distress. The agent was designed to give personalized tips based on a social issue the person with diabetes shares. A longitudinal experiment was done over three sessions to evaluate the agent. The results show that the agent is able to reduce the diabetes distress more than a plain textual delivery of tips. The successful application shows the value of conversational agents and provide a basis to deploy such conversational agents in the e-mental health domain. The design we created can be used in future work, where a further personalized approach and a tool measuring the personalization should be investigated in order to better understand why the conversational agent is able to reduce the diabetes distress. ... Read more

The coeliac disease is an autoimmune disease caused by the ingestion of gluten affecting people with a genetic disposition. Gluten is a protein that can be found in wheat, rye and barley but it can also be used as protein filler in ice creams and soup. The only treatment for patients is to follow a strict gluten-free diet. Due to the restrictive nature of the diet, coeliac people have to develop new habits and routines to overcome uncomfortable situations at home and social situations. Different studies demonstrated that coeliac people are affected emotionally by social events. Coeliac people have to avoid food contained food, be aware of the gluten cross-contamination and find proper gluten-free options. This might lead to the development of anxiety and stress. This is a master report that gathers the research and the design activities to investigate how to create a safe environment for coeliac people during social events. The project was developed through converging and diverging design approaches involving remote user research, literature review and iterative cycles of ideations, development and testing. The project focused mainly on two areas: the perception of the gluten-free diet and the coping strategies or problem-solving skills used during social events. The research approach includes context research as base knowledge about coeliac disease, the challenges of the gluten-free diet, and coping strategies. The user research involved coeliac people to lead the development of a solution that would embrace their needs and values. At the end of the user research, a Framework was developed to describe the context of the social events for coeliac people. The design goal of the project was identified as the project aims to enhance the feeling of security for coeliac people by increasing empathy and decreasing negative emotions. Different concepts were developed according to iterative conceptualizations and evaluation tests of low fidelity prototypes with participants. The insights gathered helped to generate a final concept. The final concept is an event planner app that gives information about how to create a safe environment for coeliac people and more. The final user tests have been conducted in part in person and part remotely with participants who evaluated the possibility to create a safe environment and create empathy. The results demonstrated that by using the final concept it is possible to generate a safe environment and generate empathy. Participants had the possibility to immerse themselves in the challenges that coeliac people face daily. Coeliac people indeed felt to be secure cause people would have the correct information about the preparation of the environment and gluten-free food. ... Read more

We live in a world in which chronic diseases are on the rise. Yet, improving personal health behaviours is a long-term goal, that is often undermined by alluring offers that provide instant gratification and other more pressing day-to-day matters. Often it is not the intention that is missing to change personal health behaviours, but there is much evidence that highlights a gap between what individuals intend to do vs. what they actually do (Sheeran, 2002). There are many existing behaviour change tools that provide the “solution” to a problem, yet no one solution will be effective for everyone (Hekler, Burleson, & Lee, 2013). Especially when considering health behaviours, that need to be sustained over time to have significant impact, it is prudent that interventions fit our goal, our ever changing lifestyle and are enjoyable (Phatak, 2019a). An alternative approach is to give individuals the tools to self-experiment with interventions, and through this, find interventions that work for them to establish a lasting effective behaviour change. This project explores self-experimentation (SE) as a method for helping individuals change their personal health behaviours. A research through design approach was used to answer the questions: (1) What is self-experimentation and why is it needed? (2) What does self-experimentation result in and how can it contribute to individuals achieving sustainable health behaviour change? And (3) how can design facilitate individuals to self-experiment? In alignment with these questions, this project yields three significant outcomes: First, a new take on self-experimentation was discovered; one that addresses the limitation of existing approaches and caters to the needs of people trying to change their health behaviours. User research into how people go about navigating their health behaviour, and the kind of evidence they need to make decisions revealed that: (1) People generally navigate their health behaviour through intuition. (2) People who practice self-experimentation, are not seeking to answer a hypothesis, but simply want to find an intervention that works for them, explore different options and learn about themselves in the process. (3) People can determine whether or not an intervention works for them simply by trying it out. This reveals if the intervention helps them achieve their goal (i.e. is effective), whether it fits into their lives and with their personality (compatibility) and whether they enjoy it. These insights created a premise for a new approach which was labelled “Explorative Self-experimentation”. It differs fundamentally from the existing “quantitative” method in that it omits the key ingredient of a data-driven scientifically rigorous objective evaluation of the effectiveness of interventions, and instead harnesses the intuitive evaluation formed by a user’s lived experience. By observing 14 participants undergo four weeks of self-experimentation, a set of 13 phenomena were uncovered that engaging with Explorative Self-experimentation results in. These can be summarised in five statements: Explorative Self-experimentation helps people (1) take incremental steps towards a long term goal, through (2) trial and error to success. It (3) leads people to get to the heart of the issue, (4) discover new perspectives and attitudes towards their own health behaviours and (5) find support along the way. These phenomena were linked to prominent behaviour change theories in the context of health in order to establish how explorative self-experimentation can contribute to individuals changing and maintaining their health behaviours. Finally, the research through design process involved creating three sets of prototypes that explore how to facilitate individuals to self-experiment with health interventions. The design process and the testing of these prototypes revealed three lenses from which to tackle facilitating self-experimentation: (1) designing for the process, (2) designing for different scenarios or stages of change and (3) designing for the underlying needs and values of people trying to change their health behaviours. As part of this third lens, I presented seven concrete starting points for designers to facilitate self-experimentation, linking the underlying values and needs to key ingredients design can provide. The compilation of these outcomes aspire to answer the research question of how design can facilitate SE: Designers can provide guidance through the process, designers can help initiate SE, help people maintain their efforts over time to find something that fits, or help turn fitting solutions into habits. Designers can cater to needs and values by providing guidance, incentives and inspiration over time, by making room for personal growth and flexibility, fostering personal attachment and by forming a resilient mindset. In conclusion, this thesis uncovers the potential of Explorative Self-experimentation and how to facilitate it. It presents a meta-strategy for helping individuals change and maintain personal health behaviours, and through this hopes to contribute to improving health both at an individual and societal level. ... Read more

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. ... Read more