This study centers around the development of a crafting tool within the CardioVitaal cardiac rehabilitation (CR) program, aimed at transforming physical activities into personally fulfilling experiences for patients post-rehabilitation. The design vision emphasizes leveraging health crafting theory to empower patients to discern what brings them joy in exercise. Through literature reviews, expert interviews, collaborative sessions with cardiac patients, and iterative design processes, a digital crafting application was designed. This app serves as a digital companion, offering personalized activity recommendations, action planning flows, and reflection prompts to support patients in sustaining physical activities beyond the confines of the CR program.

The thesis conu the ethical considerations in workplace health promotion programs(WHPPs)and financial incentives (FIs). While financial incentives are commonly used to encourage healthier behaviors among employees, their implementation often raises ethical concerns such as autonomy, fairness, discrimination, and privacy. This research aims to address these concerns by developing an ethical guideline to assist employers in designing, evaluating, and implementing ethically sound WHPFI programs.

The research process involved a comprehensive literature review, expert interviews, and user research through co-creation interviews with employers and employees. These methods helped identify common and contrasting perspectives on ethical issues, exploring typical ethical and unethical practices in WHPFI. The insights gained were translated into a guideline that provides employers with practical tools to assess and refine their programs.

The resulting guideline website offers a practical platform for employers to evaluate their programs against ethical criteria, understand key ethical principles, and receive actionable recommendations for implementation.

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.

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).

With the prevalence of stroke being notable in the Netherlands, there's a growing interest in understanding the psychosocial elements that guide the rehabilitation process. This study aims to develop an intervention tool to inspire greater motivation in stroke survivors to actively participate in their recovery activities.

This research, conducted as part of a master's graduation project, targets enhancing the motivation of post-stroke survivors to partake in both clinical and at-home rehabilitation. This involves examining relevant external factors and designing interventions in collaboration with the survivors themselves.

The research is primarily centered around patients from Rijndam Medical Centre, known for its wide-ranging post-stroke rehabilitation cohort and its partnership with Erasmus MC.

Two main methodologies frame this study: the Design Thinking "Double Diamond" Process Model and the Co-Creation design method. The former offers a fluid approach encompassing four stages – discovery, definition, development, and delivery – which can transpire simultaneously. The latter emphasizes active participant involvement, granting firsthand insights and feedback. Based on the insights from Co-Creation, the research involved qualitative analysis, ideation, and culminated in the project's final design and evaluation.

Initially, identity was presumed to influence the psychological constructs impacting motivation. Field research affirmed the role of external factors in shaping identity and motivation. This led to the formulation of a table categorizing factors affecting motivation, serving as a foundation for further exploration on enhancing stroke survivors' motivation for rehabilitation.

However, due to limited participant involvement, the precise relationship between identity and motivation couldn't be firmly established. Current findings suggest that focusing on stroke survivors' overall well-being and social connections may be more beneficial than solely emphasizing identity within intervention tools.

Given the research's six-month duration, future in-depth studies are recommended for those keen on this topic. It holds promise for refining post-stroke intervention strategies.

Featback is an online self-help program for people with eating problems. Someone has an eating disorder (ED) when their whole life revolves around food and body image (Saha et al., 2022). Featback is developed by GGZ Rivierduinen Eetstoornissen Ursula. It has proven to be effective in reducing ED symptoms (Aardoom et al., 2016a; Rohrbach et al., 2022). For eight weeks, users have to answer four questions per week. Based on these questions, they receive one of 1250 handwritten personal messages. Even though Featback is effective, not many people use it.

Project goal: Make Featback appeal to more adolescents who are struggling with a developing eating problem or eating disorder.
The target group is adolescents, as most people develop their eating disorder as a teen. It takes years before people seek help (de la Rie et al., 2008). However, the sooner someone gets help, the better the chance of recovery (Zipfel & et al., 2015). So, more adolescents must find Featback at the beginning of their eating problems.

Research questions are created to achieve the project goal. These are answered by using contextmapping and literature research.
People do not recognise an ED because of stigmas, denial and poor mental health literacy. Many believe only thin, young, white girls have EDs (Romano & Lipson, 2019). People with an ED do not recognise themselves in this image. Not even when they are extremely underweight. Additionally, people of all sizes, genders and ages can suffer from an ED.

Because it is found that people do not recognise an ED and thus are not looking for (online)help, the design must improve mental health literacy.
The design goal is: Create a website that helps adolescents who are developing an eating disorder improve their mental health literacy regarding eating disorders, to increase self-awareness, so that they will seek help sooner.

The redesign
In phase 1: Mental health literacy, users are educated on eating problems. They get presented with stories of situations related to eating problems. They are asked to judge these stories; his creates distance between the user and the story and creates an interactive experience.
In Phase 2: Recognition, users can do a self-test to create recognition for their eating problems. The self-test results guide them to Phase 3: Help.
In phase 3, users can make use of the online help. They can directly start with week one of the eightweek program without creating an account. In this way, users can experience the interaction without committing, lowering the threshold to use Featback.
The redesign is evaluated with ED patients and experts.

Conclusion
The redesign helps young people understand eating problem symptoms better and stimulates them to seek help. People with an ED feel seen by the website and can reflect on their own behaviour using the stories. The redesign must use other platforms like TikTok, Instagram, and Proud2Bme to attract people to the website. Finding help is hard for people with EDs; they need encouragement to do so. They often do not believe they deserve help. A safe space like fEATback can lower this threshold.

Space Mission Sanitas is a game-based health intervention to help cardiac patients maintain their physical activity level after cardiac rehabilitation. Often people find it hard to maintain their physical activity level after cardiac rehabilitation. They face different barriers that lower their motivation, resulting in an unhealthy lifestyle with low physical activity.

This project is done in collaboration with the Capri Hartrevalidatie centre. The target group for this project are the participants that are rehabilitating here. The people that come to the rehabilitation training are often open to a lifestyle change but need guidance on how to achieve this. A part of the participants are people with a low socio-economy position(SEP), for them, it is even harder to maintain their physical activity after rehabilitation.
To integrate physical activity into the daily life of cardiac patients, a game-based health intervention is designed and tested in this project. All participants in cardiac rehabilitation can take part in this game, including participants with a low Socioeconomic position(SEP). When designing the game, the barriers of people with a low SEP were considered. The game is a tool to motivate physical behaviour in the gamified world so that the experienced physical activity for the game will motivate people to perform this behaviour in the real world.
To design this game-based health intervention, a user-based literature study and a context field study were conducted. A deeper understanding of the participants’ drivers and barriers view on physical activity and needs and motivation during and after rehabilitation were gained. By combining the insights, a behaviour analysis and a user persona could be made of the target group. A design brief, including a design goal, vision and design opportunities were set up. The design goal of this project is to develop a persuasive game that supports the maintenance of physical activity in cardiac patients’ daily life by stimulating their sense of competence, relatedness, and autonomy. From the behaviour analysis, the three elements: competence, relatedness and autonomy resulted in important factors of motivation for physical activity. In the ideation and conceptualization phase of this project, the game-based health intervention got its shape. Co-creation sessions, interviews and expert validations were conducted to find the best concept direction. This led to the final design: Space Mission Sanitas.

Space Mission Sanitas is a game where six teams are challenged during the cardiac rehabilitation period to achieve their weekly fuel goal. This fuel goal needs to be reached to provide their space shuttle with enough fuel to complete the overall mission. The fuel goal can be seen as a metaphor for a weekly physical activity goal since the goals are related to physical exercise they can practice in their daily life context. Every week during the training, they will evaluate which team has achieved their fuel goal and every week they will draw and select a new fuel card for the coming week.

Finally, an evaluation cycle of one week, showed that the game had a positive effect on people their sense of competence, relatedness, and autonomy. This suggests that the game has a promising effect on the maintenance of physical activity after rehabilitation. In future research, the game will be tested over a period of six weeks to measure the actual effect on people’s physical activity maintenance. The variety of insights gathered in this project can be used in future CR research and CR health interventions.

This master thesis report is the result of a six-month-long graduation project for the Design for Interaction master at TU Delft. The report describes the development of the design guidelines to attune the TAS program to the Netherlands.
The main goals that guided the project were three: identify which aspects of a healthy habit program (TAS program) can be adapted to the Netherlands; understand how to design for it by creating a set of design guidelines; and how to apply the guidelines to attune the program to the Netherlands..
Healthy habit programs targeted to teenagers are crucial since it is the period in which bodies develop and finish forming. The early understanding of healthy habits is key to helping teenagers to acquire lasting healthy behaviors and classrooms provide a great context that supports the knowledge building experience.
The TAS program was evaluated in 103 Spanish classrooms, in different autonomous regions, and proved to increase healthy behaviors among teenagers, such as improving nutritional habits (increase of fruit and vegetable intake and decrease of fried food) or increasing physical activity. Therefore, the opportunity to adapt a successful healthy habit program to another European country was identified.
The research phase of the project consisted mainly of sensitizing activities and literature research to get to know the context and domain of the project; and interviews with Dutch and Spanish parents and teenagers to understand the reality and daily life habits by comparison.
The opportunity to design a set of guidelines based on the research outcomes was identified, a set of 10 guidelines grouped in four groups: medium, content, communication and engagement. The guidelines were applied to one of the workshops of the TAS program with the aim of evaluating the effectiveness of the guidelines and the workshop itself.
The concept was evaluated with Spanish and Dutch secondary teachers and Dutch experts in the field of health programs in order to assess the validity of the concept and identify to what extent the implemented changes were culture specific.
The project was approached from a cultural framework, in which socio-cultural dimensions served as a way to find a direction for the project but also as a tool to compare and identify cultural variables between Spain and the Netherlands.

Skin cancer is the most common form of cancer in the Netherlands, often caused by having too much exposure to UV radiation from the sun. An effect of this is that the part of the body that is exposed the most to the sun is also the body part where skin cancer is seen more often; the head. When the skin cancer gets removed surgically, the defect is sometimes so big that reconstructive surgery has to take place. This treatment is impactful for patients, since their face can abruptly change, impacting their social interactions.

This project explores the patient experience that facial skin cancer patients have throughout their treatment and how augmented reality (AR) could contribute in this treatment, to ultimately bring about a better quality of life (QoL).

In the first phase of this project qualitative research was conducted. Interviews with healthcare professionals (HCPs) and observations in the hospital helped to understand the context for patients. Contextmapping interviews with patients gave insights on the patient journey they went through. It was found that this journey can best be explained as an emotional roller coaster with a long recovery phase.

In the second phase of this project the final concept “Face it” came about through experimentation with AR software and co-creation with HCPs using the patient journey as a basis. A final interactive mock-up was created and tested with ex patients to evaluate the concept as a whole.

The final concept Face it is a tool that helps patients to look at themselves in three different ways during the recovery phase of their treatment; the current selves, back in the past and the future selves. This is done by taking photos, keeping track with photos and looking to the future phases of the recovery in AR. The final concept was evaluated as a good example of digitalization to evoke patient engagement in their own care and with that patient empowerment.

This design research showed that there is a need and opportunity for more digitalization in healthcare. Furthermore, the project has shown that solutions in healthcare can benefit from taking a more holistic approach to a problem. Taking this a different perspective offers interesting opportunities for future projects on AR in healthcare, as does this project, offering a glimpse into the future.

Currently, mental healthcare recognizes the benefits of optimal communication between patient and doctor in the treatment process. However, the protocols and therapeutic doctor-patient interactions are not yet designed to fully realize their potential, as patients who have different psychiatric symptoms often find it hard to clarify and communicate their intertwined life issues.

Hence, the thesis addresses the implementation opportunities to use the Visual Thinking and Storytelling design method to tackle this communication challenge, provide clarification and structure to help the patient voice their issues, and improve doctor-patient communication. Simultaneously, the method also allows patients to engage in Shared decision-making and receive better treatment (Slade, M., 2017). This thesis uses the mental health organization Geestelijke Gezondheidszorg (GGZ) Delfland’s ITB Support program as a context example, with the aim of proposing a new visual story communication strategy to help the GGZ Delfland improve the clarity and structure of communication between social workers and clients.

To provide better clarification and structure, a Visual toolkit was designed to help the health experts clarify the clients’ needs. In addition, a Visual strategy plan was designed to guide the GGZ Delfland on how to operate the toolkit in the ITB program. This thesis gives inspiration about how Visual Thinking the Storytelling can improve doctor-patient communication and how they can be used in practice.

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.

The aim of this graduation project is to increase physical exercise of employees with low socio economic status (SES) by engaging them in a health intervention. Individuals with low SES often negatively influence their health by having an unhealthy lifestyle. This lifestyle causes the individual problems and non-communicable diseases (NCD), which causes a shorter life expectancy and being ill makes it harder to participate in work activity. The client for this project is DZB Leiden, a re-integration company of the municipality of Leiden. DZB is there for everyone who wants to work but has difficulty keeping up with the current work practice. The people turning to DZB often experience a work disability and have a low socio-economic status. DZB also recognizes an unhealthy lifestyle among their employees. A healthier life will contribute to the well-being of the employee and will decrease employee absenteeism. Thus, not only looking from an employment perspective, but considering improvement of quality of life of their employees, DZB is determined to give a contribution to their employees’ health. To increase the physical activity of the employees, a persuasive game was designed to be played at DZB. Persuasive game design is a tool to motivate people to perform certain behaviours in a game experienced world, which can be beneficial to them in the real world. The physical activity experienced during the game can motivate people to perform the desired behaviour in the real life. In order to design a game based health intervention that will be accepted by the employees, an extensive field study was conducted. By taking a human-centered approach and co-designing with the employees a deeper understanding of the target group was created, including their view on health, motivations, barriers and needs. The findings from the field study were translated to 10 points of attention to be considered for creating the health intervention. Also, a framework for design was developed, including three motivational elements: humour, fellowship and discovery. By applying the 10 attention points and design framework, the final game ‘Sailors in Motion’ was developed. Sailors in Motion is a game where boats are hidden and searched for throughout the building of DZB in a scavenger hunt with treasure maps. Making and following these maps stimulates the player to walk around at DZB. The game is all about discovering new places in the building, which is done together with colleagues. Additionally, the game includes joyful elements. During the journey, health messages can be found, meant to educate the player about the benefits of physical activity. Finally the game was evaluated with the employees. The aim of this evaluation was to figure out whether the game stimulated to walk and triggered to increase physical activity in the employees’ daily life. The evaluation showed that the game does put people in motion and creates a immersive experience for the player. However, since the game was evaluated in a short time, the effect of the game on someone’s health awareness was difficult to measure. It is recommended to play the game more often and spread the activities over multiple weeks to provoke behaviour change. Also, the game could be part of a larger health program where employees set goals and get support to reach them. The game serves as a starting point where people can easily engage in to experience the benefits of physical activity on their mood and body. This experience can motivate them with setting personal health goals and eventually changing their behaviour. The deliverable of this project is not only the tangible game, but also a variety of insights about the employees of DZB. The company could use the framework for design as well as the 10 point of attention during future development of health related initiatives at DZB.

This dissertation focused on the added value of personalized gamification as a factor to enhance implementation potential of eHealth interventions in youth mental healthcare. Mental health disorders are the leading cause of disability in adolescents. It is important for these adolescents to go into therapy, as adolescence is a period in live in which essential developments occur on which mental health disorders have a negative impact. Although psychosocial therapies are effective in reducing psychiatric symptoms in adolescents with mental disorders, there is still room for improvement. For example, because of premature termination of treatment, poor attendance of treatment‐sessions and a low or non‐adherence to homework assignments...

Cultural differences in the business world are often met with surprise and irritation. The aim of this graduation project was to create a persuasive game design that teaches managers in an international context how to work with cultural differences. For this, the game makes use of the the cultural theoretical model that was created by Fons Trompenaars and the most extensive database on cultural values. Through interviews and context research was concluded that managers want to learn personalised and pragmatic knowledge in a quick time frame that can be easily translated to the business domain. The game should be played individually and in preparation before the cultural encounter. After a brainstorm and showing my initial ideas to possible end-users was concluded that a boat travel narrative was most accessible, and a playthrough was worked out. Multiple visual styles were explored for the design resulting in three visual concepts. These were evaluated on scalability and through paper prototype tests. The chosen concept was slightly altered to become the final concept. A minimum viable game (MVG) has been created based on the Italian culture that takes managers through a narrative in which they have to travel to an island. During the journey they receive tips about culture and on the island they have a simulated meeting with three Italians, each having a slightly different culture based off the Italian culture. This MVG has been evaluated with the target group within a limited scope to confirm that the firstly described goal of the game had been reached. Finally, the project closes with future recommendations for the game.

Asthma is a chronic disease and is characterized by inflammations of the airways. Since there is no cure available yet, asthma treatment is aimed at asthma control, to minimize patients’ symptom experiences and to prevent patients of having exacerbations (lung attacks). A key driver in this, is the extent to which patients adhere to their prescribed medication treatment, also called ‘medication adherence’. It has been found that one third of Dutch asthma patients show poor adherence to their treatment.

The client of this project, the pharmaceutical company AstraZeneca, has developed a smart inhaler in combination with an application. This technology makes it possible to measure medication adherence and present the adherence data to patients and healthcare providers. However, if the motivation of patients remains low to take their medication as prescribed, such interventions will likely not succeed because patients may ignore the reminders sent. Therefore, the aim of this graduation project is to develop a proof of concept for a self-management eHealth intervention that motivates patients to adhere to their medication treatment.

This thesis describes the development of Ademgenoot, an asthma self-management application connected to a smart inhaler. Ademgenoot uses narrative game-elements to motivate asthma patients to adhere to their prescribed medication treatment. In this, Ademgenoot focuses on the positive outcomes of taking the daily maintenance medication. Moreover, the application gives the patients the opportunity to try-out the daily intake of the medication, by offering them a six weeks challenge linked to a personal goal. During this period Ademgenoot visualizes the process of the medication intake in a playful way to make the effect of the medication visible and to prevent disengagement. At the end of the challenge, patients should have gained insights on the effect of the intake of the daily medication and their improved symptom control within their daily lives.

The design process from investigating the user’s needs and values to various idea directions towards the final design will be discussed. In addition, this thesis includes the different research that was conducted to gain a better understanding behind patients’ motives to not follow their treatment, the conducted research on the difficult step of motivating people to change their behaviour and the different user tests that were set up.

A WhatsApp prototype was built to test the concept of Ademgenoot in practice. Patients received screens responding to their medication use for a couple of days via WhatsApp. The end user test delivered the proof of principle that the concept of Ademgenoot has the ability to motivate patients to adhere to their prescribed treatment. In addition, participants expressed to be enthusiastic about the concept and stated that they would like to use the application in their daily life. A positive side-effect appeared to be that some participants mentioned that it would help in the creation of a habit.

Follow-up studies are recommended on finding additional ways to track the development of the patients’ daily wellbeing within the application. This and other recommendations are presented in the final part of this thesis.

Weight stigma is defined as the negative attitudes and beliefs that are manifested by stereotypes, rejection and prejudice towards individuals because they are overweight. Weight stigmas have a negative impact on the mental health of people with excess weight. They internalize the weight stigmas and therefore blame themselves and feel less worthy. This can cause their physical health to deteriorate and can lead to weight gain. One of the most harmful types of weight-related stigmatization is the interpersonal stigmatization within the direct social environment. The central aim of this research has been to explore solutions to reduce weight-related stigmatization within the direct social environment of people with obesity. To narrow down the scope, the project was focused on stigmatized women who show interest in body positivity and fat acceptance. This thesis refers to these women as ‘fat’ instead of ‘obese’ in order to respect their cultural values. The research was divided into a theoretical background study, a qualitative user research and an explorative study with methods including interviews, quick prototyping and user tests. The insights gained throughout the project come together into an overview of the most stigmatizing beliefs: (1) Fat people eat too much and exercise too little; (2) Becoming fat due to an unhealthy lifestyle is your own fault; (3) Losing weight is a matter of self-discipline; and (4) Slim people are healthier, happier and more successful. According to this research, the stereotypes and prejudices manifested in these stigmatizing beliefs are the result of misunderstandings and lack of knowledge. Therefore, the overview is complemented with facts and myths about weight that unravel the beliefs. Based on this overview, an interactive platform for fat women was designed: Big Fat Nonsense (in Dutch: Dikke Onzin). This platform consists out of a website (www.dikkeonzin.org), a podcast, a discussion template and social media channels. The design is based on the finding that stigmatized women often cope with internalized stigma. They first need to be empowered in order to stand up for themselves. By reading facts and myths about weight, answering the reflective questions on the website and listening to stories via the podcast, they gain the confidence to start a discussion with a stigmatizer in their direct social environment. A discussion template can be downloaded on the website to structure their conversation about stigmatizing beliefs. By answering the questions on the discussion template, the users are forced to set agreements on the desired weight-related communication within their relationship. In order to reach the target group, the design is promoted via social media channels and ambassadors. Finally, the design of Big Fat Nonsense has been evaluated with the target group and their close relationships. The design succeeded to provoke nuanced and in-depth conversations. However, to fully validate the effect of the design, it should be evaluated by measuring the amount of stigmatization before and after usage.

Taming Esortra is a persuasive game for people diagnosed with osteoarthritis. The two most important symptoms of osteoarthritis are pain and joint stiffness; making it hard and painful for patients to exercise. However, exercise is important and can actually stop the osteoarthritis from getting worse. Taming Esortra uses narrative game-elements and self-monitoring to help patients gain control over their disease. It does this by helping them gain insight in the burden of osteoarthritis and see how they can decrease that burden through exercise.

Certain professionals are inherently at risk of experiencing traumatic events, and developing the anxiety disorder Post-Traumatic Stress Disorder (PTSD) as a result. The cost of PTSD is huge, both in terms of human pain and economics. Effective treatments such as exposure therapy do exist, but obviously prevention would be preferable. There is some research into training people to become more psychologically resilient, but this is still in an early stage. Supporting resilience training with technology may offer advantages such as reduced cost and logistics as compared to in vivo training, and being able to present stressors in a very controlled manner. Measuring effectiveness with technology may be more objective than the commonly used self-reporting questionnaires.

In this thesis one possible technology supported resilience training system was designed and evaluated. The system involved video annotation and the cognitive reappraisal paradigm, delivered through three different versions of a computer application that were developed for this purpose. Two novel ways aiming to measure resilience using a pictorial emotional Stroop task and the fear conditioned startle paradigm were evaluated.

Acceptance of the video annotation tool by the target group (military personnel and firefighters) was positive. Due to feasibility considerations its effectiveness could not be measured. Empirical validation of the measurement methods as a measurement of resilience was not successful, possibly as a result of selection bias in the participating sample and use of video material that was not sufficiently aversive.