J.J. Kraal | TU Delft Repository

Redefining Measurement: Exploring Couple’s Social Interaction Data For Psychological Well-Being Assessment

Investigating how to design a hollistic and collective remote patient monitoring approach: A meta-strategy for uncovering design opportunities, guidelines, and pitfalls to support future efforts

Master thesis (2024) - B.G.A. van der Rijt (author), Jacky Bourgeois (mentor), J.J. Kraal (graduation committee member)

healthcare system. Over the next 10 years, diagnosis and survivorship rates of colorectal cancer are expected to rise due to better detection methods and treatment innovations. Therefore, Remote Patient Monitoring (RPM) is being explored as a telehealth solution, but it faces cha ...

healthcare system. Over the next 10 years, diagnosis and survivorship rates of colorectal cancer are expected to rise due to better detection methods and treatment innovations. Therefore, Remote Patient Monitoring (RPM) is being explored as a telehealth solution, but it faces challenges in addressing the multifacet and subjective nature of mental health. Current mental health assessments are often biased and limited by a Western, individualistic perspective. This creates an opportunity to design a more inclusive, collective RPM strategy that involves a patient’s social environment, especially their spouse, as dyadic coping (shared stress regulation) is more effective than individual coping. Therefore, the objective of this thesis is to investigate ‘how to design a strategy to remotely monitor and contextualize mental health by leveraging romantic couples’ collective and contextual data’.

This thesis indicated that social interaction is essential in maintaining relationship satisfaction, crucial in enhancing effective dyadic coping. A data-enabled design approach was applied to design a custom remote research tool-kit for seamlessly and compliant data collection, and contextualizing social interaction through visualizing and co-analyzing the collected data. User research was conducted over a period of 7 days (where 2-3 days were dedicated to data collection) with three Dutch, romantic couples aged between 55 and 75 years old, living together. Thematic analysis resulted in design guidelines, along with identified strengths, limitations, and future research opportunities regarding social interaction interpretation and contextualization. This thesis contributes to the design and research community by offering insights into romantic couples' social interactions and providing guidelines for creating holistic, collective RPM strategies for telehealth innovations, beneficial for cancer survivorship follow-up care.

Evalutating an educational care pathway supported by the diabetes box for patients with type 2 diabetes

A pilot and feasibility study

Master thesis (2023) - M.E. van der Maarel (author), J.J. Kraal (graduation committee member), Hanno Pijl (mentor)

The thesis consists of six chapters, including the introduction (Chapter 1), a literature study about the current state of e-health interventions in T2DM care (Chapter 2), the study design of the pilot study (Chapter 3) and the results of the pilot study about the educational car ...

Research and design with the identity-related factors to increase stroke survivors' motivation for rehabilitation

Master thesis (2023) - W. Kang (author), Valentijn Visch (mentor), J.J. Kraal (graduation committee member), S. Orozco (coach)

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 active ...

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.

Designing a lifestyle intervention for people with a physically demanding job

Master thesis (2022) - J. Beckmann (author), J.J. Kraal (graduation committee member), N.A. Romero Herrera (mentor), Pieter Coenen (coach)

Cardiovascular diseases are a prevalent cause of death worldwide. People with physically demanding jobs tend to have poorer cardiovascular health than people with sedentary jobs. In contrast to leisure-time physical activity (PA), occupational PA (lifting, pushing, and pulling he ...

Cardiovascular diseases are a prevalent cause of death worldwide. People with physically demanding jobs tend to have poorer cardiovascular health than people with sedentary jobs. In contrast to leisure-time physical activity (PA), occupational PA (lifting, pushing, and pulling heavy loads over a long period without sufficient recovery) seems to have detrimental health effects. This phenomenon is called the ‘PA Paradox’ and requires interventions that counteract these harmful health effects.
In the current occupational health research, interventions for this population are typically narrow, focusing on limited factors in a specific environment. These kinds of interventions are not effective for people with physically demanding jobs. Instead, an intervention for this population must respond to workers‘ complex context, fit their daily activities and preferences, and be integrated into their work and home environment. Therefore, this project aimed to explore these aspects to design a promising concept for a lifestyle intervention that shifts workers’ PA behavior in a healthier direction.

At the beginning of the project, expert interviews with occupational health researchers and practitioners were executed. Moreover, literature was reviewed to comprehend the PA Paradox and current approaches to counteract it. It was found that an intervention should stimulate moderate-vigorous PA, variation, and sufficient recovery and that workers must have the capability, motivation, and opportunity to perform a healthy PA behavior. Therefore, an extensive field study was carried out to investigate workers’ PA behavior and the factors affecting it. That yielded an overview of factors influencing workers’ capability, opportunity, and motivation for a healthy PA behavior. It showed that it would be most impactful to tackle workers’ inadequate risk perception and over-exhaustion. Research through design was applied to explore how an intervention could address these factors in workers’ home and working environments and what interactions fit workers’ needs, preferences, and possibilities.

The generated insights were merged to ‘Shift it!’, a concept that makes workers feel confident about shifting their PA behavior in a healthier direction. ‘Shift it!’ consists of two parts: A health week and a digital buddy. The health week starts with a toolbox meeting to make the workers aware of the PA paradox and its consequences. Afterwards, workers can visit the company doctor to examine their current health state and future risks and monitor their heart rate for one week to get insights into the intensity of their PA and the effect of their breaks.
The digital buddy ensures that workers understand the issue and helps them to integrate recovery and PA into their daily lives. It offers them inspiration, helps them find a plan that fits their busy lives, and supports them to realize it by reminding, encouraging, and praising them.

Finally, the concept was evaluated with the workers and other stakeholders to explore its potential. Everyone was enthusiastic about the concept and showed interest in implementing its elements. The health screening and the digital buddy with all its functions were identified as the concept‘s core, but it is not yet clear which elements can be realized.

Collaboration in healthcare

Building effective transdisciplinary collaborations in open innovation initiatives

Master thesis (2020) - Regina Morán Reséndiz (author), M.S. Kleinsmann (mentor), J.J. Kraal (graduation committee member), Vanessa Sattele Gunther (coach)

Emerging diseases like the current pandemic, COVID-19, and the increasing number of chronic diseases around the world are putting considerable pressure on the healthcare system, demanding for more services, with higher quality and more efficient. Hence the healthcare system needs ...

Emerging diseases like the current pandemic, COVID-19, and the increasing number of chronic diseases around the world are putting considerable pressure on the healthcare system, demanding for more services, with higher quality and more efficient. Hence the healthcare system needs to transition towards sustainable healthcare. An approach to achieve a transition towards sustainable healthcare is the Quadruple Aim. It is a practical framework that focuses on improving the health of the population, improving the work-life of care providers, enhancing patients experience and reducing health cost. To implement these four aims, it is necessary the collaboration between multiple disciplines and the implementation of an innovative approach. Open innovation provides a space for transdisciplinary collaboration and innovation to occurs. Hence, this graduation project explores transdisciplinary collaborations in the healthcare sector, focusing on open innovation initiatives. The research question for this study is how to build effective transdisciplinary collaborations in healthcare? This graduation project took place in two countries, the Netherlands and Mexico. In the Netherlands, I realised interview research in eight open innovation initiatives. Later, in Mexico, I did a case study at the Research and Technological Development Unit inside the General Hospital of Mexico ‘Eduardo Liceaga’. Afterwards, I realised a comparative analysis between both studies, followed by a design phase to build effective transdisciplinary collaborations in healthcare. The results of the two studies present a future vision and a future-oriented strategy for the Research and Technological Development Unit to improve collaboration between actors. The future vision contributes to the alignment of the actors involved in the unit so that they can work in the same direction. The strategy is formed by three strategic lines: organisational and project development support, building a knowledge community, and promote and consolidate the unit. These strategic lines aim to guide the actors towards the future vision by suggesting a series of steps. The success of this initiative could contribute to boost innovation in healthcare. A suggestion for future research is on how design can facilitate the implementation of the strategy by considering the collaboration of all the actors present in the unit.

Overcome

Reducing ICU patients' anxiety through medical alarms feedback provision

Master thesis (2020) - S.L. Cucinella (author), E. Ozcan Vieira (mentor), J.J. Kraal (graduation committee member)

In the Intensive Care Units (ICU) patients are exposed to many, continuous and highly stressors, such as medical alarms, which contribute to the development of psychological issues, such as delirium, anxiety disorders and post-traumatic stress disorders (PTSD). These psychologica ...

In the Intensive Care Units (ICU) patients are exposed to many, continuous and highly stressors, such as medical alarms, which contribute to the development of psychological issues, such as delirium, anxiety disorders and post-traumatic stress disorders (PTSD). These psychological issues have a negative influence on the patients’ healing process and dramatically reduce the quality of life during and after ICU. Medical alarms are meaningful signals that inform nurses and lead them to properly act to attend patients’ basic needs and medical treatments. However, medical alarms are not meant for patients who lack resources to cope with them. Due to their ambiguity, alarms are perceived as a threat and appraised as dangerous by patients. Nurses are the main resource for patients to cope with such a threat. Nurses have the information needed by patients to reduce their uncertainty and stress provoked by such a stressor; therefore, lack of support contributes to the risks of developing psychological issues. Designing solutions that aim to reduce the risks of developing psychological disorders during the period of hospitalization in the ICU is necessary to facilitate the people healing process and to guarantee them an improved quality of life during and after such an experience. Overcome is a feedback interface designed to enable nurses to communicate by a distance with patients to reduce the risks of developing a state of anxiety when a medical alarm goes off. Through the provision of feedback, Overcome informs patients about the nurses’ decisions over medical alarms while they are approaching the room thus restoring the perceived sense of safety. Information about the decisions made by nurses over an alarm, as well as information regarding the reason for an alarm, promote medical alarms understanding and reduce the uncertainty of dying that patients can experience when exposed to ambiguous alarms and when they have to wait longer than expected before receiving the nurses' support. Feedback reassure the patients and positively influencing their state of anxiety; also, a reduced state of anxiety may also result in reduced stress levels.

Sounds of Surgeries

Design for health behavior change in the soundscape of orthopedic operating theaters

Master thesis (2020) - Z.A. Luck (author), E. Ozcan Vieira (mentor), J.J. Kraal (graduation committee member)

Noise in orthopedic operating theaters The medical staff working in orthopedic operating theaters are often exposed to significant noise generated by many simultaneous sound events (e.g. powered tools, alarms) that pose a risk to their health and well-bein ...

Noise in orthopedic operating theaters The medical staff working in orthopedic operating theaters are often exposed to significant noise generated by many simultaneous sound events (e.g. powered tools, alarms) that pose a risk to their health and well-being. This thesis focuses on their health behaviors associated with the sound situation. Existing literature provides evidence that noise in some orthopedic surgeries can cause health issues ranging from increased stress levels to noise-induced hearing loss. Nevertheless, literature research also shows that the field of sound and health assessment has not been widely explored. Consequently, this thesis has two aims: Firstly, understanding the soundscape, its entailing health risks and the motivations of current health behaviors of the medical staff in relation to the soundscape. Secondly, contributing to an improved sound situation and reduced health risks for medical staff applying design. Sound perception and health behavior Applying the user research method “context mapping” (design method making people reflect on personal experiences) current health behaviors of the medical staff (e.g.surgeons, anesthesiologists) were investigated. In particular psychological consequences of noise are often underestimated. Sound levels in seven orthopedic surgeries (with varying surgical approaches) were assessed. Although the evaluation showed differences in sound levels, average sound levels did not exceed current legislation. Further investigations on sound characteristics(through psycho acoustic analysis) show that sound perceptions (e.g. pleasant or unpleasant sound experiences), causing psychological health impacts, are not sufficiently explained by loudness (i.e. especially average decibel levels). Based on the research findings, that some sound situations in operating theaters are in parts hazardous and that the behavior of the medical staff is often non-precautionary, a theoretical framework (based on Social-Ecological Model (SEM)) was developed. It showcases the stakeholders directly or indirectly involved in potential behavior change processes towards an improved sound and health situation in operating theaters.This framework formed the core guideline for the consecutive design process,aiming to explore how behavior concerning the soundscape can be improved. The key discovery: There is a lack of awareness and knowledge of health consequences posed by sound within medical staff, as well as on other social-ecological levels (e.g. hospital management). Design towards sound and health awareness The final design outcome, a website, targets a wide healthcare audience. The website initiates greater engagement concerning sound improvements through increasing awareness of the current sound situation in operating theaters. It caters to varying awareness levels: General information on sound and health in operating theaters (to increase knowledge and initiate awareness) and concrete action advice to transform awareness into action for sound improvement and risk reduction. Reflecting on the final outcome and future research This thesis showed that sound perception in operating theaters is still not sufficiently explored. The initial evaluation with medical and non-medical staff participants indicates that the website successfully improves knowledge, triggers reflection and thereby sparks awareness. By further extending the websites’ sphere of activities, it has the potential to contribute to the achievement of better sound quality in operating theaters. This thesis concludes with suggestions on future sound and health behavior research.