Manual scavenging, the manual removal of human excreta from sewers, septic tanks, and dry latrines, remains active in India despite prohibition under the 1993 Act and the Manual Scavengers Act of 2013. This thesis argues that the practice is not an oversight of the legal system but a product of it. The government maintains a near zero death record through semantic evasion, reclassifying sewer deaths as hazardous cleaning accidents, which denies victims their legal identity and their families compensation. Rooted in the caste system and forced upon Dalit communities as a hereditary occupation, the practice is sustained by generational poverty, institutional impunity, cultural indifference, and the deliberate absence of worker identity documentation. Without formal records, workers cannot be counted, compensated, or protected.
The research treats manual scavenging as a wicked problem that cannot be resolved through isolated, single-domain interventions. Using systemic design, it combines desk research, expert interviews with frontline activists, and documentary analysis to map the system as a set of reinforcing loops and to identify leverage points for change. The central insight is that recognition through documentation is the point of highest leverage. The outcome is Saatchi, a platform that registers workers into tamper-resistant records, issues a physical safety and documentation kit, connects families to legal aid, and educates the public through courses. ... Read more

Post-transplant patients require lifelong immunosuppressive drug monitoring to prevent organ rejection. Dried Blood Spotting (DBS) enables patients to collect blood samples at home and mail them to a hospital laboratory, reducing the burden of repeated hospital visits. Although Erasmus MC has analytically validated DBS and introduced it on a small scale, scaling it further has proven difficult. Sample quality is inconsistent, the workflow is highly manual, and no mechanism exists to communicate quality failures back to the patient or nursing specialist.

This project reframes DBS not as a technical problem but as a system design problem. Through literature review, external context analysis, and qualitative interviews across six stakeholder groups at Erasmus MC, three structural patterns were identified at the root of the scalability problem: departmental fragmentation with no shared visibility, a complete absence of quality feedback within the chain, and manual fragility throughout a workflow that cannot grow proportionally with patient numbers.

The design response is a feedback loop: a structured return path through which quality information generated at the laboratory travels back to the patient and nursing specialist in a form that enables correction. Two product interventions realise this loop. The DBS card holder is a 3D printed patient-side tool that provides an immediate spot size reference and sampling checklist at the moment of collection, giving patients feedback before the card is sealed and posted. The DBS card scanner is a bench-top imaging device for the pharmacy laboratory that photographs incoming cards under controlled illumination, measures spot diameter and circularity, identifies the best spot for punching, and generates a structured patient-linked quality record.

Technical validation established a baseline quality distribution across the DBS population and confirmed that 8% of cards contained no usable spots at all — each representing a disrupted appointment, wasted analyst time, and a patient who received no feedback. The goal is to lower this with the design interventions. In addition, analyst testing confirmed agreement with scanner recommendations in the majority of cases with no added workflow time. ... Read more

Background: Survival after intensive care unit (ICU) admission has improved substantially over the past decades. However, many ICU survivors experience long-term physical, cognitive, and psychological impairments, collectively referred to as Post-Intensive Care Syndrome (PICS). The year following ICU discharge is characterized by high healthcare utilization, including frequent readmissions and out-patient visits. Despite this burden, structured follow-up after ICU discharge remains limited. Remote patient monitoring (RPM) using wearable technology may offer a way to support recovery, detect early deterioration, and personalize post-ICU care. At the Leiden University Medical Center (LUMC), RPM has already been implemented in several care pathways under the concept of “The Box.” The ICU Recover Box was developed as an adaptation of this concept specifically for ICU survivors.

Objective: The aim of my thesis is to identify possible improvements to the ICU Recover Box for implementation into clinical practice.

Methods: A mixed-methods approach was used within the second ICU Recover Box pilot study at the LUMC. First, an analysis was conducted on all included and excluded patients, to investigate how many of the eligible patients were inducted in the study, and what where reasons for exclusion. Second, semi-structured follow-up interviews were analyzed using thematic analysis to identify barriers, motivators, and suggested improvements from the patient perspective. Third, objective compliance data (wear-time and daily ECG measurements) collected from the wearable device were analyzed to evaluate adherence patterns over time.

Results: Between July and December 2025, 830 patients were admitted to the ICU, of whom 15 were actively participating in the study at the time of analysis. The most common reasons for exclusion of the study were short ICU stay, lack of mechanical ventilation, early ward discharge, cognitive impairment, and patient refusal. Several groups currently excluded in the research setting — such as patients discharged early or those declining research participation — may be reachable in future clinical implementation through alternative distribution strategies or integration into standard care.
Ease-of-use scores were generally high (mean 4–5 on a 5-point scale), though issues were reported regarding ECG measurement errors, cognitive burden related to daily tasks, skin irritation from the wristband, and login problems after app updates. Thematic analysis revealed that internal motivation (e.g., reassurance, insight into recovery) and external motivation (e.g., perceived oversight by healthcare professionals, caregiver involvement) were deemed to positively influence adherence. Barriers to adherence included discomfort of the wristband, technical errors, unclear instructions, and difficulty integrating ECG measurements into daily routine. Analysis of compliance rates showed relatively high wear-time during the first period of the study, followed by gradual decline over time. Daily ECG compliance, requiring a conscious action, was lower than passive wear-time compliance, indicating that active daily tasks related to home monitoring are more difficult to sustain than continuous passive monitoring.

Conclusion: Implementation of the ICU Recover Box into clinical practice requires improvements which can be categorized in three main levels. At the level of the physical devices used in the ICU Recover Box, implementation depends on reducing user burden and ensuring accessibility. At the level of the app and accompanying service, it must function as a personalized recovery tool with clear and supportive communication rather than merely a passive data collection platform. At the system and organizational level, sustainable adoption requires structural embedding within clinical workflows, multidisciplinary alignment across departments involved in a patient’s care, and feasible distribution methods for the Box. Passive monitoring appears more sustainable than daily active measurements. Implementation success depends not on isolated improvements, but on the refinement across the board. Continuous alignment between technological possibilities and the clinical realities of ICU survivorship is essential to keep ensuring both feasibility and relevance of the ICU Recover Box. ... Read more

Menopause affects half of the world’s population directly and the other half indirectly, with significant consequences for women’s health and well-being. Yet, it remains under-researched and shrouded in silence and taboo. During this project, the urgency to improve the menopausal experience became evident through the voices of marginalised women in Zuid-Holland, who shared sentiments such as: “I feel like I have no use anymore,” “I really don’t want anything to do with the stupid menopause,” and “I wasn’t taken seriously.”

This project explored how the menopausal experience of marginalised women in Zuid-Holland can be improved through research and design using intersectionality theory and a macro-, meso-, and micro-level framework. At the macro-level, negative societal perceptions of ageing strongly impact women’s experiences. A tested intervention to reframe these beliefs was integrated into a global anti-ageism campaign to promote awareness and institutional reform. At the meso-level, interviews and a survey disclosed that the GP-patient interaction is crucial for shaping women’s menopausal journeys. Strengthening this interaction through improved GP education, regularly updated clinical guidelines that reflect new insights, a more supportive, midwife-like approach, and integration of AI communication tools could have a broad ripple effect. Additionally, normalising and accessible information through a national, evidence-based information hub, eventually evolving into a personalized menopause guide app, can deepen inclusivity. At the micro-level, co-creation sessions and interviews revealed that feelings of doubt and disempowerment can be counteracted through open communication within women’s close social networks. Community-based workshops, awareness campaigns, educational initiatives, and products addressing hormonal changes across ages can create the needed dialogue and understanding.

Together, these interventions form a multiple-level strategy, focused on increased awareness through stigma reduction and open communication, targeting the underlying factors that currently shape negative menopausal experiences. Their collective outcomes form a force to create the paradigm shift necessary for a future in which menopause is shared, supported, and understood.
While the project focused on marginalised women, most participants had Surinamese roots, leaving many intersectional identities underexplored. Future research should include women from other cultural backgrounds and investigate the experiences of LGBTQ+ individuals. There are also opportunities to expand beyond stigma-reduction, particularly through inclusive preventive health programmes, though further study is needed to define these interventions.

Menopause remains a largely misunderstood phase of life requiring greater attention. The strategy proposed in this project addresses marginalisation, reduces stigma, and opens dialogue where it is most needed, transforming fear and grief into a celebration of life.
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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 Box contains monitoring devices patients can use to perform monitoring activities in the comfort of their home. The success of the service relies on active patient participation. With The Box, the treating medical team now has insights in the patient’s health condition from a distance. It doesn’t require the patient to be physically present in the hospital, and there’s now even more reliable data available to adjust the treatment to. It makes the carepath insightful and approachable by both parties, resulting in accessible digital consultations. Since The Box has proven to be a success in patient care, several departments started adopting this service as well. However not much attention has been given to how the healthcare staff at LUMC is experiencing the implementation of The Box. As the idea of patient home monitoring looks very promising, the reality however is quite discrepant. Not having the physical presence of patients in the hospital, would appear to reduce the burden on healthcare staff, as instead these “empty” hospital bed will simply be taken up by other, even more severe cases, causing a larger amount of patients to both monitor digitally and take care for physically. It leaves us with the question of “Who will do it?”. Who will take on the so to speak additional workload? The healthcare staff at LUMC is experiencing more workload with the implementation of The Box as its intended use is mostly focussed on remote and safe patient monitoring, while missing out on an opportunity for assisting the care-team. It occasionally happens that additional staff is hired to cope with the excessive workload, or that LUMC is also investing in an intelligent system that prioritizes patient data. But momentarily, healthcare staff’s solution is simply to not check up on every patient that sends in data. The Box may appear as an implemented innovation in the care practice of LUMC, but in reality it is still a prototype. Therefore it requires scaling to towards an improved standard healthcare practice. The goal is to turn The Box into a mature proposition that can be implemented hospital-wide, but also that has the ability to change the current healthcare system. The burden on the care-team must be suppressed or else the future will include an immense scarcity of healthcare professionals of which the majority will be burnt out. A roadmap is created to show opportunities for continuous prototyping and what value it brings, scaling strategies, patient monitoring and what level of staff involvement it demands, required developments and finally stakeholder collaboration. What it actually proposes are the changes to be made to create an integrated healthcare solution that is focussed on “unburdening” the staff. LUMC is not capable of changing this alone: they are specialized in research, education and healthcare, yet they lack expertise on data management, financial resources, digital developments, etc. It therefore needs support of multiple organisations. The deliverable aims to show a designer’s perspective on scaling The Box from a prototype level towards a mature healthcare proposition. ... Read more

This project envisions the future of telemonitoring for peri-operative care. Through an extensive literature research and further expert and context exploration, a design strategy is created, as a starting point for the development of new services and technologies in healthcare around surgical environments. The design process with a strong focus on analysis guided the development of the project. This allowed the creation of a future vision that considers the findings from the literature, user and trend research and gives a direction to the current state. Within the creation of a future vision, different scenarios are detailed, to give a more detailed idea of how peri-operative care would be. In addition, some recommendations and future steps are presented, to facilitate the achievement of these future scenarios by providing the stakeholders involved with some tools to assess the viability of implementation and inclusion in planning. Finally, the project includes a call to action to develop technologies and services that enables the extension of care to the home context and the empowerment of patients to have a conscious and active role in maintaining and seeking their wellbeing. ... Read more

This thesis presents the results of the project “Creating meaningful conversations user-data”. This project aims to understand the impact that interactions with technology currently have on users and to redesign a fitness tracker service to create more personal and meaningful experiences. These experiences enable fostering the users’ wellbeing and ultimately user engagement. The project explores the personality (conceptual characteristics) of the fitness tracker and its impact on user interaction. Moreover, it researches the meaning and value of health for the individual. These trackers are perceived by the users as very controlling in the interactions, which are mainly based on outputs and behavioral instructions leaving the user a passive role on the experience (conversation). The reason is that trackers follow a machine personality approach based on optimization and goal-seeking. Moreover, it has been found that the value of health for the tracker follows a different approach than the user. While the user values health to find balance and self-care based on doing holistic and meaningful activities, the trackers approach health as a predefined list of activities and are based on performing and achieving. This tracker approach zooms in on the activity (tangible meaning), difficulting for the user to see beyond and find the personal meaning that these devices can have to transform their lives (intangible meaning) into a healthier life. To design a more meaningful conversation user-tracker, five specific challenge areas related to this problem have been found: meaningless and impersonal goals, trainer tone of voice, linear and achievement focus, perceived lack of self-control and lack of health balance. The redesign is a new concept for the fitness tracker service (mobile and smartwatch app). It tackles the entire concept of the fitness tracker service (mobile and smartwatch app), rather than only data visualization because there needs to be a common ground regarding the personality of the user and the tracker (such as having a common approach to health) before the user-data conversations can become meaningful. The redesign zooms out from tangible activities and frame goals as journeys towards a healthier life. In this journey, the user is not only supported in the achievements but also empowered in the lower points of the process though self-reflective questions to learn from his unconscious behavior, which makes the service a platform for self-growth and gives the user a proactive voice in the conversations user-tracker. Moreover, a meaningful topic of conversation is established from the beginning of the experience by the “goal-setting” where the user can define holistic and personally meaningful goals to design his future-self. Finally, the motivation strategy of the app has been shifted from competition and achievement to share learnings with others (Self refections) regarding the journey, since it has been found that in this context, motivation related to de creativity. Therefore the user finds meaningful the experiences that inspire their behavior rather than instruct it. ... Read more

This thesis presents research on data and healthcare and proposes a design vision that enables collaborative use of self-tracked data. This work was developed within the Cardiolab as a graduation work in Strategic Product Design. It aimed to identify the needs and aspirations of practitioners and patients and, then, embody the findings on a design vision.
To develop the design vision, literature research was carried and user research was done with healthcare professionals and patients. Mixed methods were used to collect and analyze qualitative data.
The results have revealed that trust plays a key role in a data-based collaborative system. It enables users and professionals engagements and provides value to other stakeholders involved. Furthermore, the research has revealed that ethical uses of data are critical to unlocking interactions in such a system. Based on that, a platform called "Insight .me" was designed.
From a design perspective, this thesis emphasizes the need for enabling data as material for personal reflection and collaboration, besides, it reinforces the need of designing ethical and trust base businesses to deal with self-tracked and personal data. ... Read more

Cardiovascular diseases (CVD) are the leading cause of death worldwide. While metabolic factors such as age and gender affect greatly, most of the CV events can be prevented by addressing behavioural risk factors such as physical inactivity, smoking or bad diet.

CV prevention programs aim to reduce the burden of these conditions by providing guidance to individuals and predict negative outcomes, but adherence to these programs rely heavily on individual capabilities and intrinsic drivers. The proposed product-service system enables self-management of risk prevention programs by tracking progress and adapting to interactions with the app.

The product enables self-assessment and individual strategies for each risk factor as well as connectivity for future appointments in the prevention program.
Based on different personality types, the system tailors the tone of information presented to the user to nudge and motivate the user with intrinsic drivers and capabilities such as health literacy. ... Read more