This report is the result of a graduation project about Schistosomiasis, a neglected tropical disease caused by the Schistosoma parasite. And about a new technology to detect the parasitic infections. More specifically, to detect the urinary Schistosoma type, called S. haematobium.

Within Africa, a large number of countries are affected by this parasite. The transmission happens via water and is almost impossible to stagnate. It influences children and adults by reducing their ability to grow, learn or work on full capacity. Both the economy and living conditions of entire communities suffer from this worm, which lays its eggs in the human bladder. Ghana is an example of an endemic country in which the entire population is at risk of infection. By the support of the government, they have established a nationwide control programme, with annual Mass Drug Administration (MDA) in all the high risk areas to control the morbidity. Ghana was therefore selected as main scope within this project.

The new technology detects the parasitic infection by counting the number of eggs in urine samples. This new technology is faster, easier and more reliable than current methods and able to add value for different types of users. A literature study and three weeks of user research in Ghana revealed the diagnostic needs of five user groups: researchers, control programmes, urban hospitals and rural health facilities in low and high endemic areas.

The greatest value can be added when designing for researchers and rural health facilities. So, a product is designed to fit the main requirements of both user groups. This resulted in one product for both, but with an additional application on a tablet for the researchers: The EC (Egg Counter). The product is easy to use and maintain for remote facilities. Those areas are confronted with a lack of resources and specialist. The EC enables lower educated people to execute diagnoses and takes away the need for specific medical equipment. For researchers, the additional application will facilitate digitalised data collection. The product is robust and portable as the researchers will take it with them on field trips, for large-scale community screening. The product will be much faster than the current procedures, saving a lot of time in the field and thereby money.

The EC is designed for Ghana, with a side focus on Nigeria. With some small adjustments and a slightly different implementation plan, the same product can serve these different countries. But more development and research is required until it is suitable for implementation in the other endemic countries.

This graduation project has been carried out in the context of the research project ‘Tailored Healthcare through Customer Profiling’ at the TU Delft, in collaboration with hospital Reinier de Graaf Group in Delft, and medical device company Zimmer Biomet. Together we focus in this project on the rehabilitation journey after total hip replacement (Total Hip Arthroplasty, THA).

The central aim of this project has been to find out how different patient profiles benefit from different interaction features in the rehabilitation device ‘BioCoach’, to effectively support them in their rehabilitation process.
This project investigates how a tailored version of the BioCoach could meet the needs and wishes of three different patient profiles: the ‘optimistic’ patient; the ‘managing’ patient; and the ‘modest’ patient.

Assignment. The Usher Syndrome is a hereditary disorder, where people's sight and hearing degenerates over time. As a result, being socially involved with other people can be challenging, especially in rooms that are low-lit and that include background noise. The project was initiated to help people with Usher Syndrome to still be able to socially involved, regardless of such challenges. Hence, the project assignment is stated:

“To design a non-stigmatizing, portable and affordable product for people with Usher syndrome, that offers enhanced control over lighting and/or acoustics, with the goal of improving their sense of involvement in social contexts.”

Methods
Methods used in tackling this assignment are the classic design cycle by Roozenburg and Eekels, accompanied by the diamond model of Buijs. The design cycle entails evey step of the innovation process where in every step - by using the diamond model - information is gathered (diverging) and narrowed down subsequently (converging), steering many options to a single defined design outcome. Important steps are evaluating ideas and validating concepts with end-users, to ensure a meaningful product is realized.

Results. As a result of the deficits caused by Usher, having conversations with other people can be challenging. Especially, in a dark and noisy context like a bar or pub: the design context in this project. In understanding a conversation, speech contains the most information. By aiding the sense of hearing, speech intelligibility can be improved and in turn the sense of social involvement. Important functions to for a design for people with Usher is this context is separating speech from background noise, reducing the distance between the speech source and person with Usher, allow volume control over the speech source and enable a connection with the hearing aid(s) and/or cochlear implant(s) of the person with Usher. Current products do not offer such functionalities.

Functions and requirements are ultimately translated into a design proposal: a microphone system called Micall. Micall is a system of small microphones that can be divided among friends/family. These Mics can pickup sounds from each person individually rather than capturing an entire scene like current microphone aids do. Speech is now separated from background noise and is made more intelligible. Feedback received from validation tests shows that the project assignment is validated: Micall is a non-stigmatising, portable product with enhanced control over acoustics and improving sense of involvement in social contexts.

Conclusions. After a full design project has been performed, a solution is found to the project assignment: Micall.
Micall proves to assess the main functionalities as stated in the project assignment by the validation of the end-users.

Discussion. A realisable design proposal is made, which can be developed in the near-future. However, more focus is needed on the sound engineering and manufacturing sides. With more advanced models deeper use insights can be gained. Also, investment models should be researched in order to come up with viable ways of developing, producing and selling the product.

Move On is a graduation project which is focused on redesigning the HandsOn game, a therapeutic game for arm-hand rehabilitation which is developed at Roessingh Research and Development (RRD). The HandOn game is a ‘mixed reality’, i.e. a video game played by interacting with physical objects. It trains grasping and horizontal reaching movements in a rehabilitation context. The game is mostly used by adults aged 50+ with hemiparesis, weakness at one side of the body, due to stroke. Design Assignment:
The goal of the HandsOn redesign is to include training vertical reaching movement and motivate stroke patients in starting, enduring and repeating the game.Design method:
The Persuasive Design Method is used to structure the redesign process (Siriaraya, n.d.). First the “transfer effect’ is determined, being the therapeutic effect to be aimed for by the game. Second, the “user real world” is analyzed involving the user, its motives and values and its context. Thirdly, in the game design phase the persuasive game will be iteratively designed with the aim to increase an experience of a game world in the player. Subsequently, this game world experience is designed in such a way that it facilitated realization of the transfer effect (phase 1). Finally, an ‘evaluation’ is conducted on whether the game design causes the ‘transfer effect’.Transfer effect:
To determine the transfer effect regular arm and hand therapy exercises are analyzed, therapists are interviewed and a literature study is conducted. It can be concluded that arm and hand rehabilitation exercises can be decomposed in various elements. Every rehabilitant needs a unique combination of these elements, which a therapist is able to estimate.
-An optimal rehabilitation effect can be reached through tailoring the game for the abilities of the player.
Long term motivation, for about three months, can be reached by:
-Communicating to the rehabilitant what he has reached within therapy through progress feedback
-Showing the relevance of exercises by real life simulation
Motivation during play can be reached by:
-A challenging, but not too challenging, task
-Multi-sensory feedback
-A clear start and end of the task, to work towards to

User real world:
The user real world, i.e. the user-experienced rehabilitation context, is analyzed through interviews with rehabilitants, which confirmed the motivational factors exposed in the research for the transfer effect.
The greatest wish of all rehabilitants is to live independently again.
This inspired a game theme focused on daily life tasks that rehabilitants were used to do at home.

Game design:
An effective, motivating game for arm and hand rehabilitation broadly exists of three steps: 1. Tailoring trough game settings, 2. game play which includes moving physical objects and 3. Reflection through progress feedback.
Based on these steps, three design directions were developed: gamifying daily chores, a game revolving around tea and a game about chores in- and outside the house. These design directions were evaluated with healthcare professionals, and two were chosen to elaborate into concepts.
In the ‘Tea Time’concept, the player runs a teahouse and should serve orders, physical objects, to his customer, being coasters placed on a table.
In the ‘Joblocks’concept, the player simulates different chores in- and outside the house with the use of ambiguous objects.
Both concepts are evaluated on their therapeutic and motivational effect and feasibility. Tea Time was choosen, since it is indicated to be most feasable.
A prototype of Tea Time was created for testing.

Evaluation:
The prototype’s game experience and motivation towards therapy were tested by four rehabalilitants. They played the game three times in three weeks and filled in questionnaires and were interviewed about motivation and game experience.
Two therapists reviewed the prototype for points of improvement.
It can be concluded that the game creates motivation towards arm and hand rehabilitation. Game experience stayed almost the same over three weeks, which indicates players can play the game for weeks without getting bored.
Game experience itself was ranked neutral. Game experience can be increased by more accurately tailoring the game’s challenge for the individual rehabilitant.
Recommendations are made for an improved game, which has main focus on better tailoring physical challenge by:
-objects that vary in shape and weight
-more placement possibilities of coasters
-more variety in time limit
And better tailoring cognitive challenge by:
-Multisensory cues for playing
-Possibility to reduce sensory stimuli
-Adding an easier level

It is expected that the new recommended prototype will meet the therapeutic requirements and motivates and challenges rehabilitants.

Currently 30% of all knee prosthesis patients do not return to work after surgery. This is partially caused by the insufficient guidance of the patient's care providers. the most important care providers in this are the occupational physician and orthopaedic surgeon. The current collaboration is experienced by both the occupational physician and orthopaedic surgeon as impersonal, uninvolved and inefficient. This leaves the patients to feel insecure and uncertain before and during rehabilitation. The developed platform combines all information concerning the patient's function recovery and work reintegration in one overview available for care providers and patient. The platform stimulates direct communication and mutual support based on their separate areas of expertise.

Malaria is a life-threatening parasitic disease and the leading cause for high morbidity rates in developing countries. In Nigeria, the chosen context of this study, over 90% of the population is at risk of malaria infection, leading to 60% of the outpatient visits in Nigerian healthcare facilities. Accurate diagnostics are not available for the mass and drugs can be bought without prescription, leading to misdiagnosis, overtreatment and drug resistance.

The Excelscope is a smart malaria diagnostic device that leverages the functionalities of a smartphone to capture magnified images of a blood smear and provide a remote or automated diagnosis. The concept was developed by students from the faculty of Industrial Design Engineering and is currently under development of a research consortium. The Excelscope aims for increasing accessibility to accurate malaria diagnostics. Three scenarios for the diagnostic analysis of a blood sample (remote, semi-automated and automated) were the starting point of this research.

The technology analysis evaluated the three defined scenarios for remote or point-of-care diagnostics. Based on an initial analysis, the assumption was made that the semi-automatic scenario was most feasible in the context and best accepted by healthcare professionals (doctors, nurses, lab scientists). Furthermore, the technology analysis briefly discussed definitions related to eHealth, resulting in several ideas for applications for the Excelscope. Finally, a study into similar technologies for malaria diagnostics was done. An integrated system for imaging and automated parasite detection has not been launched on the market yet, although several organizations and companies are working on similar technologies.

The context analysis consists of four chapters: Nigeria, her healthcare system, malaria and -diagnostics. Next to literature research and expert interviews, Insights were gained during a one-month field study in Ibadan, Nigeria. During the field study, healthcare facilities were visited and caregivers participated in semi-structured interviews. The context analysis resulted in a country profile (including general aspects about economy, living standard and health), an overview of the healthcare system and insights on each tier of the healthcare system. Coverage of malaria diagnostics can significantly increase when a device is implemented in primary healthcare centres, pharmacies, medicine stores or medical outreaches. However, the Excelscope has to meet the minimal infrastructure at these places: little or no access to reliable water, lack of internet connection, low-level medical staff and ‘robust’ environments.

Current ways of diagnosing malaria were studied as well and evaluated according to WHO’s ASSURED checklist. Microscopy and rapid diagnostic tests are the recommended methods for confirmation of a suspected case of malaria. However, both methods lack on different aspects, such as affordability, availability or accuracy. In development of the Excelscope, the checklist can be used as guidelines for basic requirements. However, aspects related to context (infrastructure and accessibility) and user (behaviour, attitude and trust) are essential in order to develop an effectively used device.

Throughout this project, emphasis has been placed on the user. The goal of this study was to find barriers and enablers for use and acceptance of the Excelscope by healthcare professionals in Nigeria. During the interviews with stakeholders in Nigeria, the different scenarios were discussed, as well as local perspectives on malaria management in general. Through the interviews, six potential target groups were defined: patent medicine vendors, pharmacists, medical doctors, nurses, laboratory scientists and medical volunteers (community health workers). For each of the target groups, suggestions have been given for smartness of the device, values and mHealth applications.

The study is concluded with a ‘roadmap’ wherein all findings are connected in a framework of technology, context and user. The framework can be used for defining a target group or anticipating on necessary developments in order to increase.