Honors ggd health battle 2016 report by jolijnvs

Honors GGD Health Battle 2016 A report on designing for child vaccinations in The Netherlands By: Vera Henricks Laura Power Jolijn van Sleeuwen Chiara Treglia

Table of Contents

Abstract Introduction Overall Vision Stakeholders Current Situation Research Scientific Paper Review Technological Review Observations BMR and DTP Process Short and Long Term Goals Final Concept Theme Environment Digitalized System Future Conclusion Individual Refections Vera Henricks Laura Power Jolijn van Sleeuwen Chiara Treglia Acknowledgements References Appendix

4 5 6 8 10 12 12 15 16 19 20 25 26

38 38 39 40 41

Abstract Joining the GGD (Community Health Services) Health Battle 2016, we were asked to think about the future of public health and to propose ideas and innovations in a competition between several teams of universities and professional educations. We decided to focus on vaccinations as part of the Dutch national vaccination program (Rijksvaccinatieprogramma), starting by looking at bad experiences encountered by children when they are vaccinated. We believe that the current vaccination program is very efficient and beneficial to public health, but there can also be some changes made to advantage all of the parties involved. This report proposes a procedural design for the vaccination events for 9 year old children in The Netherlands. We have redesigned the procedure in a way that incorporates the physical experience with an interactive digital interface. In the report we describe and explain our research in the vaccination field and the process we took to create our final design for the GGD. We also explain how it will benefit the GGD, children and their parents, and potentially public health on a wide scale level. We have both short term goals for the GGD Health Battle as well as long term goals for the rest of the year regarding the improvement of vaccinations in The Netherlands, which will also be explained in this report. We hope you enjoy reading! Vera, Laura, Jolijn and Chiara

Figure 1: Vaccination needle

Introduction

As a team, we foresee several design opportunities that address issues relating to pain and fear management during vaccination procedures. As prevention is seen as one of the main goals in the medical and healthcare field of this century, too little research and design has been done in proposing options for a less stressful vaccination experience.

Design and Chemical Engineering, and different nationalities; Dutch, English and Italian. This diversity and our technical background benefit our project for the GGD Health Battle.

In Europe, countries have adopted specific yet diverse vaccination schedules which babies and children have to undergo at different ages. As documented in researches and literature, often these scheduled vaccinations require young patients to face high levels of stress, accompanied with the perceived pain, before, during and after the vaccination procedure. Besides this, a traumatic vaccination experience can leave children with negative memories for the rest of their lives. In fact, children who associate vaccinations with revulsion, fear and distress are likely to inadvertently raise a generation of future teenagers and, later on, adults, who are much less willing to have immunizations or injections. Therefore, we want to address this issue and design a solution for child vaccinations so they have a positive memory of the experience. We want to do this for a specific context and have focused on the DTP and BMR vaccinations which are compulsory for every 9 year old child in The Netherlands. As well as having short term goals by implementing our design, we are also pursuing a long term goal for our design to have effective outcomes on a societal level and to improve public health for the future. We are one of the two teams from Eindhoven University of Technology (TU/e) taking part in the GGD Health Battle 2016. Composed of students from the TU/e Honors Academy, undertaking the Honors track Empowerment for Health and Wellbeing, we are a diverse and eager group of students. We consist of four members from different studies, Industrial

Overall Vision

While working on this project, our vision on the future of vaccinations has evolved into the process shown in Figure 2. This chapter will give an overview of this vision, starting from a ‘non-memorable’ or positively remembered vaccination experience, through to environment changes and the digitalized system supported by the new environment.

The implementation of a digitalized vaccination system for the Rijksvaccinatieprogramma will be a first step towards a digital health service. This system would be easily extended with, for example, travel vaccination advice and vaccinations which are new on the market. The latter would address the concerns stated in the letter on vaccination care to the chairman of the House of Representatives (de Tweede Kamer) on the 3th of July 2014.

For the future, we believe in a vaccination experience for children where they will either not remember it or remember it to be good, so a negative memory does not remain. As evidence suggests, a bad experience with needles will support needle fear later in life. This fear will also affect others, such as classmates and future children. To break this loop, it is important to give today’s children a positive experience. By creating a welcoming environment, we believe that it is possible to significantly decrease children’s distress and fear of vaccinations. Using distractions, education, autonomy for the child and the effect of children on their peers, the children will be more comfortable and less likely to remember any bad experiences. This will help the individual by reducing stress and it will quicken the GGD vaccination procedures as a result of fewer panicked children. Next to this, it will benefit the public health of society long term as people will become more willing to undergo procedures involving needles, such as vaccinations, STD tests, surgeries and more. Later in the project, we started thinking about the digitalization of the system, such as invitations, registration and administration. This will help smoothen the process, reduce stress and save time and paper. By implementing a ‘kids area’ in this digitalized system, children’s needs and questions can be answered and they will come to the event more prepared. When this digitalized system and the environment support each other, a link between the digital and physical world can be made, making the vaccination events a logical process of successive steps for both children and parents.

In short, a digitalized system combined with a changed location environment will allow for less stress and fear in children, improvement in public health as people will become more willing to take medical care, less paper use for the GGD and a clear overview of all vaccinations for the GGD and public advantage.

VACCINATION PROCESS

PRE-VACCINATION

This email contains information about ďŹ lling in the vaccine passport for the kid and resgistering for the vaccines DTP BMR

Parents receive tickets for the vaccination event.

Use website or application on phone. Recommend app.

Fill in info about vaccine history of the kid

VACCINATION EVENT

Kids are in charge! They can choose a color!

KIDS ENVIRONMENT

Scan ticket on phone (app) or printed paper (website). The color of line appears on the screen so that the parent and kid know in which queue they have to line up.

- story telling of character - info about vaccinations - learn environment

CONGRATULATIONS! Parents receive reminder for the event

You have received your BMR and DTP vaccines! Do you want a picture? With your parents? Or just to leave a message?

INTERACTIVE WALL While waiting the kid can interact with the wall dividers between the queues, which have the same environment as the kids envirionment. There is also a screen with pictures of kids who had a vaccination already.

3 3 AFTER VACCINATION The picture is added to the vacine passport

Figure 2: Our redesigned vaccination procedure

After the vaccination, kids can have a look at their picture in the application, can look back into their history, or ask for travel vaccines.

Stakeholders Giving the children a central position in the stakeholder map makes clear that the GGD and parents play an important role for these 9 year olds. You can see this illustrated in the Figure to the right. Parents influence their children in the way they would like the kid to experience the vaccination and whether the parents want the child to be vaccinated or not. A parents stress or anxiety is also often passed on to their child. Religion, could play a role in this. It might be that religious parents have the opinion that a vaccine is not needed because God will decide it upon their children. Brothers and sisters could influence the child because of earlier experiences they remember and have passed on to their sibling, either good or bad. The same counts for peer students. It could also be that the teacher also gives attention to the event. There is no particular school program what coincides with the vaccination event yet, but the teacher could inform the child before the event and maybe show understanding after the event. Lastly, the GGD plays a major role. The GGD basically decides, in cooperation with the National institute for Public Health and the Environment how, when, by whom and where the vaccinations take place. The GGD is in charge of the overall process of the vaccinations and provides important information and answers.

Overall Vision

Overall STAKEHOLDER MAP Vision

RELIGION

LOCATION

PARENTS

OLDER SIBLINGS

9 YEAR OLD STAFFMEMBERS & NURSE

PEER STUDENTS

TEACHER

Figure 3: Stakeholders of the vaccination program

Current Situation

Overall Vision

In order to work towards a goal and to make progress, it is important to clearly have in mind the current situation and how you believe the future should look. The current situation will therefore be described in this chapter where we will summarise the present vaccination model.

the child will receive and optionally a letter from the youth health care. In the letter is some short information about the vaccinations with a reference to the brochure on who provides the vaccinations. The time, location and what to bring, namely the calling card and the child’s vaccination booklet, are clearly stated. Furthermore, the voluntariness of taking part in the ‘Rijksvaccinatieprogramma’ is stated and the letter provides information on what to do when the child is ill, has an handicap or when there are other questions.

At the moment, the vaccinations in the RIjksvaccinatieprogramma are divided over several phases, 1 to 4. In phase 1, infants at the age of 6 weeks until 14 months receive vaccinations at a health centre (consultatiebureau). Since we will focus on the vaccinations provided by the GGD and especially those for 9 year olds, we will not look into the vaccinations in phase 1 further. Phase 2, 3 and 4 are provided by the GGD at the age of 4, 9 and 12 years old respectively. At these moments, the children receive vaccinations for diphtheria (D), tetanus (T), polio (P) and pertussis (kinkhoest)(K), parotitis (bof)(B), measles (M) and rubella (R). At the age of 12, only girls receive the vaccine for human papillomavirus (HPV), against cervical cancer (baarmoederhalskanker). In 2014, 95% of the children who received an invitation for a vaccine in the Rijksvaccinatieprogramma actually got the vaccination. Our main focus is on 9 year old children who will receive the BMR and DTP vaccinations, the vaccines of phase 3. For these vaccinations, several events are organised 4 times a year. These events take place at local gyms distributed over the region. Therefore, the following part of this chapter will give a short overview of the vaccination process for these children, from the invitation to leaving the vaccination event. Several weeks before the vaccination the parents receive a letter with an invitation. Attached to this letter are calling cards for each vaccination, a brochure with information about the vaccinations

After receiving the letter, it is up to the parents to prepare their child. There are of course no set rules for this, as every child and parent are different. Then, the parent takes his or her child to the vaccination event at a gym or hall. Here they go through the administration and vaccination procedure. For children with special needs, because of a handicap, fear or another reason, there are special facilities and they are allowed more time. For a more detailed description of the vaccination procedure, see the chapter ‘Observations’. When the vaccinations are done, the child and parent leave the gym or hall. Here, it is again the task of the parent to help their child process the vaccinations and events of the day. As observed, this is very different per child.

Overall Vision

Figure 4: The current vaccination program in The Netherlands

Research

Overall Vision

Scientific Paper Review Hospitalization experiences are highly associated with physical and mental pain. This occurs due to several different factors concerning the environment, the medical staff and the patients’ conditions. Pain is a feeling that everyone experiences in life as it accompanies one of the most important instincts of self-defence; fear. However, it is surprising how relatively little research has been done to control it and manage it, especially when it is unnecessarily occurring in the healthcare field. In 2014, the 4th Biannual International Multidisciplinary Pain Congress underlined the urgency of taking actions against unnecessary suffering when it comes to medical procedures. While great improvements have been done since since the 50’s, when the so called Bonica Era started, a real understanding of pain is still topic of discussion. In the 60’s, the hypothesis that a more comprehensive model to describe the stages of pain was needed was raised. Since that moment, pain was not seen anymore just as a local phenomenon of stimulus responses due to tissue damages, but also as an emotional state regarding behavioural aspects. We based our research on a biopsychological model of pain, called the Loeser model, explained in this conference.

Figure 5: Loesers model of pain

Figure 6: Loesers motivational component of pain Given that “pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (Pain, Suppl 3, 1986), our focus has been oriented to the most peripheral layers of the Loeser model, namely “suffering” and “pain behaviours”. Suffering “corresponds to all the negative affective responses induced by pain, and by fear, anxiety, stress, loss of loved objects and other psychological states. The language of pain is used to describe suffering, regardless of the cause” (4th Pain Congress). ‘Pain behaviour’ is “the things a person does or does not do that are ascribed to the presence of tissue damage. Examples include saying “ouch”, grimacing, limping, consuming health care, lying down and refusing to work” (4th Pain Congress). These two components of pain might occur even in absence of tissue damage and are strictly related to the environmental circumstances that encompass the pain experience. In fact, “affect, social setting, past experiences, and anticipated consequences alter the responses of a noxious event” (4th Pain Congress), to that of an actual occurrence of tissue damage. The fundamental idea is that, regardless the origin of the pain, it can be considered in a sense, neuropathic.

Current Situation

Overall Vision

Our team has been inspired by the huge amount of design opportunities that address these two pain components in the context of children vaccinations. Two research papers, Inadequate Pain Management During Routine Childhood Immunizations: The Nerve of It. (AnnaTaddio, MSc, PhD, RPh1,2; Christine T. Chambers, PhD, RPsych3,4 Clinical Therapeutics/Volume 31, Supplement B, 2009) and Psychological Interventions for Reducing Pain and Distress During Routine Childhood Immunizations: A Systematic Review (Christine T. Chambers, PhD, RPsych1,2; Anna Taddio, MSc, PhD, RPh3,4; Lindsay S. Uman, BA2,5; and C. Meghan McMurtry, BA2,5; for the HELPinKIDS Team* Clinical Therapeutics/Volume 31, Supplement B, 2009) constituted the scientific background on which we developed our concept.

for diabetes). Thus, individuals that fear needles are assuming higher risks than the general public for morbidity and mortality “(Taddio, 2009).

Atraumatic care is a form of care that aims to minimise distress during medical practice. This is essential when is comes to child immunisations as it has short and long term consequences. “Needle phobia is a widely publicized adverse consequence of untreated needle pain and develops in ~10% of the population. Needle phobia usually develops in childhood, after a negative experience at the doctor’s office. (Taddio, 2009) Other research suggests that children of approximately 11 years old with severe needle fear, will become the group of people that develop needle phobia. (Veerkamp & Majstorovic, 2006) This while needle fear seems to become lesser as the children grow older. (Veerkamp & Majstorovic, 2006) As 11% of the 11 years olds in this research had severe fear of needles, this backs up the research by Tadio. “There are considerable consequences from fearing needles. For example, children and adults with a fear of needles avoid seeking medical care. Once these children have grown to be adults, they generally decline dental treatments, avoid regular healthcare visits, and are nonadherent to preventive healthcare measures (eg, vaccination, blood donation) and medical treatment regimens (eg, insulin injections

Children are proven to feel higher pain compared to adults and this condition might cause unnecessary anticipatory fear responses that are primed in their memories. Anticipatory fear and its pain behaviour can be easily prevented by means of different pain management strategies. These strategies involve the environment and the agents that will have a role in carrying out the vaccinations. The most effective yet less applied ones are distractions and coping or promoting attitudes actuated by adults, parents or medical staff. A good preparation for the child can enable him or her to cope with their fear in a positive way in which small steps can be taken by different stakeholders in order to change this societal attitude that considers pain as the worthy cost of good health. Paradoxically, pain related to vaccines has been identified as a direct cause of vaccines non-adherence, which is the main reason for less effective immunization. In their second study, Taddio and Chambers conduct a broad research on methods that might be adopted to alleviate pain during medical procedures. The paper underlines the effort by which the research has been kept free from biases. Although this systematic approach in avoiding biases makes the outcomes of the study difficult to assess on a statistical basis, some strategies gave interesting results. Our team found it particularly relevant to focus on childrendirected distraction, as it seemed to be effective in reducing self-reported stress. Coaching strategies, either parent-led or nurses-led, showed to have some influences in the overall process as well. Noticeably, conducting a behavioural intervention by means of a combination of all these strategies gave the best outcomes in terms of reduction of self-

Overall Vision

reported distress. However, cognitive-behavioral methodologies are the less applicated so far, because they are considered to be unfeasible in terms of time and costs and more studies are needed to confirm their validity.

NEGATIVE LOOP

> 90% of toddlers and 50% of primary school-aged children: severe distress during immunization. In NL 19% of 4-6 year olds, 15% of 7-9 year olds and 11% of 10-11 year olds are affected by needle phobia.

Teenagers undergoing prevention vaccines for sexual diseases. Aversion to needles = doubts about the value of new vaccines and willingness to submit to them.

Parents rate of distressing events in hospitalization: 1째 waiting for their child during surgery 2째 needle punctures procedures!!

Up to 25% of adults have fear of needles; just approximatily 12% of 12.000 cases would get a vaccine, even if for free!! In NL 1 person in 1000 would not allow blood withdrawal or vaccination due to fear of needles.

Figure 7: The negative loop of needle phobias

Overall Vision

Technological Review Technological implementation is an essential part of our concept. By means of an interactive and intelligent system, we try to move towards the digitalization of healthcare services, starting from the vaccination event for 9 years old children.

The entire process we designed is based on mobile technologies, therefore smartphones with integrated cameras and pdf readers need to be mentioned as necessary tools to make the data and information flow, as well as to generate interactions with the users.

However, we believe in the importance of a real life experience. Technology makes it possible to transform the current vaccination procedure into an educative yet positively memorable and fun experience. Besides, some interactions reduce the focus on the moment of injection, therefore by making it less traumatic.

All the listed technological implementations are already existing and used in different domains. The innovation and complexity of this system relies on the combination of these technical systems. We will further explain how these technologies will be integrated into our final design and concept later in the report as we describe our final idea and implementation.

While choosing which technologies might be implemented to transform the vaccination process, some considerations in terms of budget and time have been taken into account. Although the goal was to maintain the expenses for a potential realization and application of the system within the current budget, extra initial investments will generate in turn greater savings in the long run. Saving time through the entire procedure will be the major positive outcome in the application of the system. The technologies necessary for the realization of the proposed system and revised vaccination event are listed as follows: Vaccination Digital Passport System: GGD Database: all the information about the residence of families should be associated with their email address; HTML, JAVA or similar programming languages: graphics of the digital passport and its functions. Vaccination Event: QR Scanners, mobile and/or fixed; Camera.

Overall Vision

Observations In order to understand the current situation of the experience of injections, and to get inspiration about how to improve this situation, an observation was planned. 9 year old children get their BMR and the DTP vaccination at a mass vaccination event at a local gym or big hall, together with many other children. This experience is especially interesting for our research because this is the moment that the children can be exposed to a negative experience, which could be the first stage of the negative loop, as described earlier. The observation was conducted at a local vaccination event of the GGD Brabant Zuid-Oost, in Helmond on the 18th of November 2015. About 600 9 year old children were invited to this event in a local gym. The building had one big hall where three specific phases in the process of vaccinating could be distinguished. After entering the building, the parents and children had to go the administration, where a staff member asked for the calling-card, the vaccination-booklet and controlled the date of birth of the child. When everything was approved, the stamp was placed in the vaccination-booklet and the parents and the child got two paper sheets, each representing a vaccinations (BMR and DTP). The parents and child continued to the queue where they had to wait in the line to get the vaccination. At the end of the queues, screens were set up to make a separation between the vaccination tables and the queue. The last phase was the actual vaccination, where the child was placed on a chair between two staff members to get both vaccinations simultaneously. After the vaccinations the children and parents left the hall at back side, and walked down a corridor back to the entrance where they could leave the building. This process took place in a long queue where every phase was carried out, one after the other. There were 3 queues to choose from since there were 3 vaccination tables.

For children with remarkable fear or special treatments, there was a special bench located on the side of the hall close to the normal vaccination tables. They waited on the bench until they were asked to go to a separate chamber, where possible loud outcries could not be heard by all the children waiting in the hall, and where the staff members could take a bit more time to give the child the vaccines. By means of the note taking technique and the Ad Libitum Sampling method, an approach that is about observing whatever seems interesting at the moment, two persons each took 15 minutes time to observe each specific phase, the entrance and exit moment and the special chamber. We observed from 12:00 until 14:00 and set special focus on the behaviour of the children and parents. After two hours, a lot of observations were discovered. A selection of them related to the experience of the children and parents and are interesting to take into account for a new concept are listed below. Also, see Appendix, page 57, for the photos we took. It’s “all good” A girl that just finished her vaccination is running forwards through the corridors, towards the exit of the building. Her mum says to her ‘If you want you can have a look in the hall if your friend is still waiting’. The girl runs enthusiastic to her friend waiting in the line and she expresses that the vaccination is “all good” and that she does not have to be afraid. This was interesting to observe in order to understand the dynamics between kids who just received a vaccination, and kids who still need to receive one. A lot of papers A mum with her son is entering the hall and is looking for the administration. With one hand she holds the hand of her son, and with one hand she is carrying a

Overall Vision

lot of different papers. While she is walking towards the line she is looking at the different papers and she accidently drops all the papers on the floor.

Look to the wall and count to ten The special room, where children with special fear are being treated, is a dressing room of the gym, with completely white walls and a small red matt on the floor in case kids will faint or want/need to lay down during a vaccination. A girl and mum enter the room with the staff members and they ask the mum to take place on the chair, and to place the girl on her lab. The nurses explain the procedure, that they will count to ten, with three they will place the injection and with ten it is over. They also mention that the girl should look to the wall.

The vaccination card At the administration the staff member asks the parents for the vaccination card. This is a card where all the vaccinations of the ‘Rijksvaccinatieprogram’ are listed and where the approval of the vaccinations are marked with a stamp or handwritten date. A mum brings the ‘Groeiboek’, where the card is stored, but she can not find it. This occurs two times later on as well. Parents or child? At the same administration desk the staff member tells the parents that the child has to make both upper arms ‘clear’ for the vaccination. Then the staff member turns to the child and asks ‘What is your date of birth?’. Lastly, the staff member gives the two paper sheets, which are representing the proof of the BMR and DTP vaccination, to the parent. Choice of queue A mum and daughter just left the administration desk and had the possibility to choose between three queues. Child: ‘I want to wait in the longest row’. Mum: ‘No the faster the easier, so we go for the shortest queue.’ This was interesting to observe in terms of how children make choices for the queue and how parents play a role in this. Screaming A girl took place between the two staff members at the vaccination table. The girl behaves like she does not want to get the injection and starts screaming just after the injection was inserted. Another staff member makes the comment: ‘Now it will be fun for the other kids’, implying that distressed behaviour of one child has a negative effect on other children.

As previously mentioned, this observation was initiated in order to get a better understanding of the vaccination process and to get inspiration on how to improve the situation. Analysing the observations in combination with the scientific reviews resulted in a few insights being gained. Positive feedback The girl who just received her vaccination, running back to the waiting line in order to calm her friend, was a remarkable observation. This is especially since the GGD tries to separate the children leaving and entering the building, because they want to prevent children who just received a vaccination from frightening children entering the building by their possibly sad expressions. Unfortunately, the logistic route the GGD used is also not convenient for sharing positive experiences, assuming that there are more children with positive experiences. Distractions In terms of distraction there is nothing that could help the children, except for their parents and maybe other kids nearby. The sound in the gym is echoing and in the special room the nurses point to the white wall where there is nothing to focus on, so the distraction is minimal.

Overall Vision Paperwork During the observations, it was noticed that parents bring a lot of papers to the event, even papers that are not required. With a digital future in front of us, we wonder how this could be optimized to make the process even more efficient. Autonomy Analysing what the staff member at the administration says to who makes clear that the staff member only asks the the date of birth to the child, everything else is communicated to the parents. The letter is sent to the parents, the timeslots are defined by the GGD and the choice of waiting line is often defined by the amount of people. We question how much autonomy each child has? And where could more autonomy for the child be applied in the vaccination process? In order to undergo this observation, we were required to create a research plan. This plan had to have formal agreement from our Honors coach, which it did, to show that we had set realistic as well as challenging goals relating to the vaccination events. This research plan can be found in the Appendix, paged 58 to 64. In addition, a copy of the vaccination information brochure can be found in the Appendix, page 54 to 56.

Overall Vision

BMR and DTP We conducted research into each vaccine in order to understand more about the vaccinations that 9 year olds receive. We will here provide a short summary of the vaccines purposes and the main areas of the body that each one protects.

B is based on parotitis (bof). Parotitis is an infection of the salivary gland in the cheek which can lead to numerous worse diseases. Because of this infection, the cheek becomes very swollen.

D is based on diphtheria. The diphtheria bacteria produces a toxin that causes tissue damage. Depending on the place of infection, this can cause swears, breathing troubles or heart problems.

M is based on measles. Measles causes flu like symptoms and red spots on the skin. In bad cases, it can also cause pneumonitis (longontsteking) and meningitis (hersenvliesontsteking). M protects the skin, lungs and brains.

T is based on tetanus. Tetanus causes stiffness and cramps of the muscles. This can be deadly in case too many or the wrong muscles, such as lungs and heart, start to cramp.

R is based on rubella. Like measles, rubella causes flu like symptoms, but also a rash on the skin. The rash is mostly situated on the neck and face and behind the ears. Like measles and parotitis, it can be a cause for worse diseases.

P is based on polio. In case polio infects the spinal cord or the brainstem, it causes paralysis. P protects the nervous system and therefore the body as a whole.

Process

Overall Vision

Participating in the battle, we were challenged with an open assignment to think about the future of public health and improvements in this field. Quite quickly, we found our main interest on vaccinations and the pain and fear associated with them. Consulting with our GGD coach, Caroline told that pain elevation may not be the most appropriate route to take for the improvement of public health. Therefore, we decided to look more closely into the experience of vaccinations as this has also other facets other than pain management.

influence and memory. Combining ideas from the brainstorm yielded two concepts. The first concept was based on distraction, to make children less scared. By using several themed tents and needles, children would hopefully pay less attention to the actual vaccination and gain some autonomy by choosing the theme they liked best.

We set the goal, â&#x20AC;&#x2DC;design to make childrenâ&#x20AC;&#x2122;s experience of receiving injections more pleasurableâ&#x20AC;&#x2122;. This goal perfectly fits our interest in the subject and is backed up with research, such as the negative loop. To give more direction to this goal, we chose to initially focus on the Rijksvaccinatieprogramma and the group of children from 4 to 19 year olds for multiple reasons. First, this is within the domain of the GGD and the Health Battle. Secondly, for a lot of children the vaccinations in the Rijksvaccinatieprogramma are one of their first conscious encounters with the medical world. We believe that the vaccinations of the Rijksvaccinatieprogramma and the manner they are handled can have a big impact on the way children will feel about the medical world later in life. A brainstorm on concepts relating to our design goal, specifically relating to pain, and target group generated multiple ideas, clustered around the syringe, distractions, rewards, the environment of the event and the autonomy of the child. A visual of this brainstorm can be seen in Figure 9 to the right. Finding that these concept ideas were mostly appropriate for 9 year olds, we decided to concentrate on this age group. At this age they receive two vaccinations at the same time, which also probably has a bigger influence on their emotional view towards needles. Therefore, our design can have a more significant impact on reducing this negative

Figure 8: Tents and needles from concept one

Figure 9: Brainstorm on our design goal relating to pain

Process

Overall Vision

The second concept concentrated on education and coaching so that the child would understand the vaccinations better and be comforted through good preparation. Possibilities were to do a small experiment and start education activities at school. Important in coaching was the involvement of the parent also.

the behaviour of children. One particular observation was a girl, who had just received the vaccination, running to a friend to reassure him that all would be okay. This observation research is mentioned on pages 16 to 18. Rethinking combining the first two concepts and taking into account the observations generated the start of the final concept. We decided to concentrate on tents around the vaccination tables, queue dividers and a means to let the children reassure their peers like the running girl sharing her experience to her friend that we observed.

Figure 11: Tents, queue dividers and theme sketch

Figure 10: Educational model sketch, concept two After presenting these concepts at the Mid Demo Day, we received a lot of useful feedback. It was agreed that it would be best to combine the two concepts, considering that the second concept would be inefficient in time and money for the GGD. Another interesting point that arose was to consider the time before the vaccination, such as receiving the invitation and talking to classmates. Shortly after the Mid Demo Day, two members of the team went to a vaccination event for 9 year olds at the gym in Helmond to observe. This provided good insights into the procedures of the event and

Next to this, we started thinking about a theme. This theme would both distract and communicate educational matters to the children in a understable way. Inspired by a tip from our coach, Roy, about IV bags for children that are â&#x20AC;&#x2DC;disguisedâ&#x20AC;&#x2122; as superhero medicines, we decided to base the theme on herolike characters. We conducted a prototyping session with a range of scrap materials, as seen in Figure 13. This inspired us with ideas for the queue dividers and tents, and we each explored different shapes and structures for the redesigned event. Here we were able to express our ideas clearly to each other using the prototypes we made, speeding up the design process.

Figure 12: Sketches of possible design paths

Figure 13: Creative session to generate tent and queue divider ideas

Figure 14: Mindmap of vision ideas

Current Situation

Overall Vision Short and Long Term Goals Deciding that we wanted to continue this project after the GGD Health Battle 2016, we needed to set a short term goal for the battle as well as a long term goal for afterwards. We agreed on continuing work on the changes to the environment for the battle and chose to present this at the competition. For the long term, we wanted to start on a digital system for the vaccinations, as we had already been playing with the thought of digital elements in the queue dividers, preparation of the child together with his parents, concerns about bringing new vaccinations to the public and the development of e-health. However, during a coaching session it became clear that our long term goal would add much value to our final concept for the GGD Health Battle. We decided to make a set-up for a digital system, based on an app, combined with the changes to the environment and the theme. Soon we realized the possibilities and benefits that such a system would bring. For example, education knowledge and preparation for the children, the smoothening of the administrative procedures, the use of less paper and therefore money saving, and the possibility to easily expand the system with other matters around vaccinations such as travel advice. Eventually we propose a new set-up for the Rijksvaccinatieprogramma, consisting of the digitalization of the vaccination procedure and changes to the event environment, both supported by the hero theme. With this set-up for the Rijksvaccinatieprogramma, we believe that the childrenâ&#x20AC;&#x2122;s experience of receiving injections will become less unpleasant, which is an achievement of the original goal. Next to this, the set-up will create a start towards digital health and make the procedures around vaccinations more efficient and clear.

Final Concept

Overall Vision

The final concept consists of 2 subconcepts: changes to the vaccination event environment and the digitalization of the vaccination system. These subconcepts support each other and are both based on the same theme involving numerous vaccine related characters.

(bof), measles and rubella) and DTP- (diphteria, tetanus and polio) vaccinations. As explained earlier in the research section of the report, we discovered what areas of the body the vaccines target and how they help people. We used this research to tailor some of our designs for the hero characters. For example, T protects the muscles and therefore we designed it to appear strong and lean.

First the theme will be described, then the digitalized system and the environment. Theme A theme has been created to communicate a positive feeling as well as educational matters to the children. Next to this, it distracts the children from the actual vaccination and therefore makes the experience less daunting. The theme consists of 6 characters; the heroes. These heroes correspond to each individual part of the vaccines, BMR and DTP, therefore comprising 6 characters in total. These heroes are used in both the digitalized system and in the changes we have made to the environment of the vaccination events. In the digitalized system, the heroes are used to communicate educational matters and to prepare the children for their vaccination. During the actual vaccination event they are mainly used as distraction for the children and to make the experience more pleasurable and personal. Next to this, the heroes give a more positive and happy feeling to the whole vaccination procedure that a child goes through. Infecting someone with weakened disease carriers so they make their own antibodies against the disease is hard to explain to children. To still give them an idea about this principle of vaccination, the heroes are used. The heroes are equivalent to the antibodies and they will protect the children against these illnesses after the vaccinations. Therefore, the heroes are based on the vaccinations that protects the 9 year olds from illnesses. These are the BMR- (parotitis

The colours of the heroes are chosen to be happy colours, to give everything based on the theme a positive feeling. Although red can be considered a happy colour, we chose to avoid it because it can also come across as aggressive or can be linked to blood which may put off children. The colour themes and characters are also incorporated in the queues at the vaccination events. Consequently, the colours were chosen to be easily distinguishable to avoid communication problems at the event and throughout the procedure.

Current Situation

Overall Vision

Environment By making changes to the environment of the event location, the experience of the children will change. Making changes that create a comfortable, safe, enjoyable environment will prevent children from having needle phobia and negative vaccination memories. The changes to the environment consist of queue dividers, tent-like dividers around the vaccination tables, a photo area, floor arrows and equipment for administration. Next these will each be explained individually in more detail. Floor arrows ESD silicone floor arrows will be used to direct patients around the event. For example, at the entrance, queues, vaccination tables, photo area, toilets and exit. This makes it clear for both the parents and children which way to go. It also makes the event easier and more efficient for the GGD since they can say “Follow the blue arrows” or “The toilets are at the yellow arrows”.

Queue dividers Queue dividers, roughly 140 cm high, are placed between the queues, after the administration and before the vaccination tables. The dividers provide distraction in multiple ways. First of all, they are corresponding to the colours of the heroes. After administration, the parent(s) and child are directed to the queue with the colour chosen by the child. On the dividers are all kinds of things to see, such as the heroes, fun facts about vaccinations and unusual materials to touch and squeeze. Here the dividers should bring about a happier, less stressful atmosphere for the children and parents. In having previously chosen which colour queue they want, the children have some autonomy in the queuing line. Next to this, screens are embedded in the dividers. On these screens, photos made in the photo area after the vaccination are displayed. These photos show happy children with the heroes, therefore reassuring the children. Showing photos of children that are happy after the vaccinations will show the children in the queue that the vaccinations were not harmful. This way, they can be assured by their peers, which is in the eyes of children is more credible than adults telling them that everything will be ok. The children might even see someone they know which should put them at ease. The dividers are about 140 cm high as this is the average height of a 9 year old, giving children the option to peek over in case they are curious or the option to seek a bit more privacy while waiting in the queue. This way, a child can do as he pleases. He might be distracted be a child on the other side of the queue or seek some solitude.

Figure 15: Representation of a redesigned event

By means of wheels and handles, the dividers are easily movable. For the staff present, it is important that all equipment is easy to set up and cleared away.

Figure 16: Representation of queue dividers with screen in the center

Overall Vision

‘Tents’ The tents are in fact high queue dividers that are placed around the vaccination tables in a kind of semi-circle. They prevent a direct line of sight from the children from the queue to the vaccination table. They can be placed in such a way that children being vaccinated can feel more privacy and feel protected while not feeling locked up. This is beneficial for both the children in the queue and the children that are being vaccinated. The waiting children can only get a peek inside and can thus choose to look somewhere else. Other children might want to see what is happening inside and also have this chance. The child in the tent has some more privacy and will feel more at ease, because only his parent and the nurses are in his neighborhood on no other unknown people.

Photo area The photo area is placed near the exit of the vaccination location. While leaving, children and parents have the option to take a picture with the heroes, who are present as big cardboard cutouts. Also, training nurses could be hired to dress up as the characters to pose for a picture with the children. This turns the attention of the child away from the vaccination he just received. It assures that the last thing that happens at the vaccination event is a happy experience. The picture is not compulsory as some children might still be distressed or do not want to take a picture.

On the other hand it is important that the child does not feel locked up, as this might increase stress. On the tents the child can see all kinds of things, such as the heroes and other objects. This will distract them and gives nurses the opportunity to bring the child’s attention to something else than the vaccination in case needed. Using distraction during the vaccination helps prevent troubles during the procedure. The nurses can use images on the tent to distract a nervous child, e.g. asking to count the number of tentacles on a hero. For the child, it will seem as if the procedure went much quicker than expected.

The picture can then be sent to the screens in the queue dividers and to the personal account of the child in the digital system. Like said at ‘queue dividers’, showing children in the queue that their peers are still happy will assure them. Afterwards the child can see back his picture and remember the good parts of the vaccinations. At the photo area is also some information available of the possible aftereffects of the vaccinations and what to do about it, such as moving the arms to prevent stiffness. This information is mostly for the parents, as they might also have some questions. It will also help them answer their children’s questions to put them at ease.

Current Situation

Overall Vision

Digitalized system Today, all invitations and administrations are handled on paper. Also, the preparation and the follow-up of the vaccination for the child is completely dependent on the parent and hardly any material is supplied for this. Next to this, there are concerns about bringing vaccinations that are new on the market to the public. The digitalized system will attend to these matters to make the vaccination procedure more pleasant for children, parents and the GGD. First, the system will be explained along the path of the use for the Rijksvaccinatieprogramma as a parent and then the functions. Set-up In the system, all adults from a certain age have an account. Possibly the account is attached to an already existing digital system, such as DigiD. They can reach this account via the computer or an application on their phone or tablet. The system needs to be available to all users, therefore having multiple ways of reaching it is important. The accounts of children are attached to those of their parents. The parents can easily reach it in their own account. The account holds information about age and gender, vaccination history and other information concerning health and vaccinations. For the first use of the system, some of this information is filled in via the already existing database and the missing information has to be filled in by the user. This gives a clear overview of your personal information about vaccinations and those of your children. The GGD will also have a database of their clients and the vaccinations they received.

Invitation and registration (Figure 17) A few weeks before the vaccination of a child, the parent receives a notification with an invitation on the digital application. This saves paper and money for the GGD, as all invitations are now sent digitally. Of course, the option of paper administration should still be available when implementing the system as not everyone can or wants to use the digital system. At this moment point, the parent gets some information on the vaccination, like todayâ&#x20AC;&#x2122;s usual letter. Then, the parent needs to register for an available time slot; choosing a date and location. A location and time slot are proposed to the parent, but in case another time slot, date or location suits better, the parent has the opportunity to register for another available time slot. Registering for an available timeslot gives the parents the option to choose what is best for them. This will likely result in parents arriving on time with their child, which also benefits the GGD and the efficiency of the vaccination event. Choosing your own time slot also encourages parents to sign up for a vaccination quickly, otherwise their ideal location and time may fill up.

Figure 17: Choosing a time slot

Overall Vision

Preparation for the child (Figure 18, 19, 20, 21) After confirmation of a location, date and time, the parent has the option to show her child the kidsarea of the digital application. Here, the child can play an interactive game to learn about BMR and DTP. The game helps the children to get prepared in their own way, as some children do not want to know anything while others need more information to understand what is happening. The game is based on the heroes, where they explain the reasons for vaccinations and the areas of the body that the each hero helps. After the game, the child can choose one of the heroes. This hero is linked to one of the queues at the event, where the child will see the hero again. The game and choosing the hero also gives the child some autonomy which should put him or her at more comfort. Choosing a hero, and with that a queue, will give the GGD the possibility to evenly distribute children over the event to prevent queues from building up. Queues that have a lot of votes can disappear from the options list for the other children choosing.

Administration and vaccination (Figure 22) Arriving at the event at the chosen time slot, the parent scans the QR-code to administrate. This also saves paper and will quicken the process of administration. The scanner device will remind them of the chosen colour that their child picked earlier in the kids section of the application. The parent and child then go to the queue with the corresponding colour queue to wait for the vaccination.

Afterwards, the parent receives a QR-code and all registration information. The QR-code is used for administration at the vaccination event. The parent can have the code and information easily stored on their phone or they can print it out if they so desire. This gives a clear overview for the parent and reduces the hassle for parents that do not like a lot of paperwork. Reminder Parents will receive a notification reminding them of their location, date and time slot for their childâ&#x20AC;&#x2122;s vaccination 2 days before the event, along with the downloadable check-in document. This is useful for the parents and the GGD. It will remind the parents, therefore resulting in less no-show children at the events.

Photo area While leaving the event, the child can take a picture with the heroes, possibly next to dress up characters, large cardboard cut-outs or using a green screen filter. By using the QR-code, this photo is send to the childâ&#x20AC;&#x2122;s account where it will be stored with the vaccination data on their application. The happy pictures are also manually sent to the screens in the queue dividers in the event hall. Resultantly, children who have not yet received their vaccination are assured by the smiling children they see on the queue dividers screens. This turns the attention of the child to the photos on the dividers, instead of focusing on the vaccination experience, therefore making the event more pleasurable. After the event Later, the child can look back at the picture on their device, as a happy memory after the vaccination event. This is also a talking point between children as they can share their pictures with each other and discuss about the heroes. This should remove some focus from speaking about the vaccine instead to speaking about the theme and characters. Long term (Figure 23) When the child grows to become an adult, he or she can manage their own account and take over from their parent. They can use the vaccination history to see which vaccinations they have received and to see

Current Situation their previous vaccination photos as a childhood memory. This overview can help for example in case of medical issues. This is useful for the GGD as people can keep an easy track of their medical history and know which vaccinations they’ve had. It was save time for the GGD as they will not need to regularly tell people their vaccination history. When they then have children themselves, their accounts will be linked to the child’s account and the cycle continues. The repeated cycle should improve public health long term due to adults passing on their positive vaccination experiences to their children. Functions as part of the digitalized system Memory storage Here the person’s vaccinations history with possibly the picture from the corresponding vaccination event can be viewed. QR scanner This is used for administration at the event and to send the photo of the child to your application’s memory storage. Travel (Figure 24, 25) Here all information about travel vaccinations can be found. It has the function of choosing a destination which will tell you which vaccinations are needed for this place. Also there is a link taking the user to a page where they can discover where to receive the correct vaccinations. News If there is news about new vaccinations or a epidemic, this information can be found here. In case of urgent news in the user’s local area, there will be a notification as an alert. For all pages and a working PDF app, see Appendix.

Overall Vision

Figure 18: Starting game screen for your child

Figure 22: QR code to scan at the event

Figure 19: Educating a child in the kids area

Figure 23: Vaccine history with photo view option

Figure 20: Child can choose their favourite hero

Figure 24: Travel notification on home page

Figure 21: Child has chosen character green

Figure 25: Travel advice section

Future

Overall Vision

In the short term, our plans for the future consist of a testing session of the entire concept together with parents and kids. Specifically, we would like to test the usability of our website’s interface and the information flow with parents. It is important to make sure that the design of the interface is suitable to gather information about vaccines, besides facilitating the registration procedure for their children’s vaccination.

Children’s next vaccination

From the kids’ perspective, it is important to test how they interact with the educational game we designed for them and if the message of how useful and beneficial vaccines are is conveyed. Moreover, it is essential to test whether having this educational game on their parents’ mobile interface is able to create an interaction between the parents and children. According to our research, this direct interaction will help to create a bound of trust and to cease the common anticipatory fear among children. We would like to test whether our concept makes children deal better with the idea of being vaccinated by making them feel in control and aware of the usefulness of being vaccinated. At the vaccination event, we would like to test how the entire procedure would be facilitated. Ideally, we would like to assess how much time would be saved by means of digital documentation. Moreover, we would like to test how the distraction factor influences children’s behaviour, reducing the stress during the injection moment, but also while queueing with their parents. In the long term, we believe the realization and implementation of our system in the Dutch society will lead to major beneficial improvements for the entire healthcare system. For instance, if we observe the table below, we can make some considerations upon the spreading of some less common vaccines such as HPV vaccines.

Every year the amount of girls who are vaccinated against HPV increases, showing that a constant spreading of knowledge about the effectiveness of this vaccine increases the consent among parents and the willingness of getting it among children [1]. However, the fact that the percentage of vaccinated girls is not as high as the general percentage of kids vaccinated against other illnesses is an indicator of another case of study. In fact, other research demonstrated that as children get older, less vaccines are dispensed. There are several possible reasons that might cause this phenomenon in the Dutch society, as in many others. In fact, the national health care does not ignore this problem and is actually working on possible solutions. E.I. Schipper, Minister of Dutch Public Healthcare, in a letter dated 3rd July 2014, remarks her personal commitment to improve the current situation. In the “Brief vaccinatiezorg”, (freely translated: letter vaccination care), she proposes a model she intends to apply in the early future, in order to take responsibility in preventive healthcare and in order to well distribute vaccinations among the population. She underlines the need for information and more structural advice about the full spectrum of the vaccine care, as many new and effective vaccines have reached the market, but the lack of information leads to a scarcity of request to undertake them. See Appendix, pages 48 to 53, for the complete letter from E.I Schipper. The new model E.I. Schippers foresees, is to launch a new collaboration structure in terms of an assessment party of vaccines. Based on their advice, the ministry of health care could decide for a specific distribution method of the vaccine within the different channels of:

Current Situation 1) providing vaccines via the Governmental Programme, the Rijksvaccinatieprogramma; 2) include vaccines in the package of insured health care; 3) leave it to the free market.

Figure 26: Vaccination table In this perspective, our projectâ&#x20AC;&#x2122;s goal is aligned with the Dutch public health goal. In fact, together with an interactive interface to ease the procedures for the 9 year olds vaccination event, we provide parents with a consistent platform from which they can gather any useful information for their own and their kidsâ&#x20AC;&#x2122; immunization.

ion

Overall VisConclusion

This report has discussed the development of a new vaccination procedure for BMR and DTP vaccinations for the GGD. Combining the insights of the scientific studies, observations and our own creativity, we have gone through an extensive design process which led to a redesigned vaccination procedure. Concluding the whole report we believe that the implementation of the digitalized system, the queue dividers and the photo feature offers the children and their parents a more autonomous preparation and a so called atraumatic vaccination experience. As honors students we have the opportunity to work further on this project in the upcoming semester. As written in the chapter of future plans, we have planned concrete steps to test and improve the concept as it is right now. We are happy to share our upcoming research and further developments with the GGD if they so desire. We were thankful to be involved in the GGD Health Battle and it gave us the opportunity to work in a specific context with expertise help, and to work directly with stakeholders in the healthcare field. Overall, we are pleased with, and proud of, our final design outcomes and are looking forward continuing this project in the future.

Group Reflection

Overall Vision

Individual Reflections

Overall Vision

Vera Henricks Choosing the Empowerment for Health and Wellbeing track in the TU/e Honors Academy meant stepping out of my comfort zone of the straight-tothe-point mind set of chemical engineers. I still chose to do so, because of the open feel and the creative and hardworking people I saw in the track and my need to see something else outside of the department of Chemical Engineering. Leaving my comfort zone has of course its advantages and disadvantages. Starting on the GGD Health Battle 2016, we formed a team of 3 Industrial Design students and 1 Chemical Engineering student. Since being the odd one out and not being used to a design project like the rest of the team, I felt being one step behind many times. However, I have learned many things which I will be able to use when I am in a similar situation. Firstly, I have seen a different approach to a problem. Always iterating and rethinking our process felt a bit useless to me at the time, but looking back I can see how it really improved the concept. Secondly, working on an assignment without any real boundaries was something I had never done. I have learned that it is not one of my strongest points, though I have found some tools to make it easier. Examples are setting boundaries for yourself, keeping clear structure and rethinking your process. I will be able to use these tools better during the next part of our project. Lastly, having the GGD as a real â&#x20AC;&#x2DC;clientâ&#x20AC;&#x2122; and a nonfictional goal makes the project much more palpable and real. This way, the Health Battle provided the chance to truly make a difference and see how the world works instead of just working for a good grade in class.

In conclusion a short view on the concept. I believe that the combination of the changes to the environment and the digital system can really make a change to the level of fear a child experiences during vaccinations. The concept will be most effective when it can be adapted to children of all ages receiving vaccinations and start the process of preparation, education and follow-up on the youngest age possible. Then the concept will really be an improvement to public health. Next to this, I expect the digitalization of the healthcare system within a few years. Starting with a digital system for vaccinations will give the GGD itself many advantages, such as a more adaptable system and less paper costs. It will also open up possibilities in other branches of health care and follow the trend of the increasing use of technology.

Current Situation

Overall Vision

Laura Power Healthcare is an area of design that both intrigues and excites me. I have found it motivating to conduct a project that has reachable long term goals even after the GGD battle is completed. My work and contribution to this project feels more valuable than in a usual design project because the results are meaningful for the GGD and possible future implementations. Also, working alongside healthcare professionals has been educative because I have learnt to deal with design constraints such as budgeting and time efficiency. I have been responsible for a large part of the graphics within the project, designing and creating the hero characters, part of the digital application and the final report. Hereby I developed my ability with graphic software and have experienced an iteration process of graphic designs. Moreover, reading and analysing scientific reports in the research phase of this project has enhanced my professional writing. Immersing myself in this project has enabled me to get a true understanding of the vaccination procedure from a childâ&#x20AC;&#x2122;s perspective. This has both developed my empathy and user focus skills. Additionally, working a motivated, talented team has inspired me in new areas of design. I have experienced new ways of brainstorming and methods to visually represent information which I have then applied to my study. I believe we had an equal workload in the team, therefore fulfilling one of my personal goals since I habitually take on surplus tasks in a project group. The open design space provided freedom to choose a direction of personal interest, therefore making the project more stimulating. I have thoroughly enjoyed the process due to its dynamic style involving numerous stakeholders. I am also especially passionate about this project due to its complexity, competitive nature and future possibilities.

Current Situation

Overall Vision

Jolijn van Sleeuwen In one of the first honors meetings in September 2015 it became clear that we as team would participate in the GGD Health Battle. The general kick off meeting helped me to get insight on what the GGD is working on and I realised that our project could have impact on the preventing public health landscape in the Netherlands. This impactful aspect is one of the major reason why I chose to do the Honors Track of Empowerment for Health and Wellbeing. To go into the field, collaborate with stakeholders and work together with the highest motivated team members. An important insight I gained is that by immersing yourself into the context of the design space, you get a good understanding of the design space, which could lead to a problem solving design. Within the process of the project, in which we designed for the 9 year old kids receiving a BMR and DTP vaccination, I tried to immerse myself into their shoes and try to connect with the stakeholders. My own 9 year old experience of the vaccinations, observing at a vaccination event in Helmond, interviews with moms, kids and staff members of the GGD and experiencing needles my own by giving blood at Sanquin. These activities helped me to get inspired, to get insights and become highly motivated to address the situation. These activities made me also realise that healthcare and design can cause complicated situations, especially when the patient comes in. Due to privacy issues, the risk of testing with real patients, the sometimes conservative and protecting attitude of doctors and the inflexibility of the healthcare system make design activities in the health context challenging. I have learned to come up with a concrete goal, a firm research approach, to design consent forms and adopt my attitude and communication towards stakeholders in different hierarchies. The level of flexibility that I have practised will make me stronger in any future design- or collaborative process.

Within the process we tried to design for a specific target group which is about 188.000 children (2015). Next to the big size of the target group, the parents are also strongly related to the kids experience. Given these two facts it was a challenge to design for mass and in the same time being not paternalistic towards parents. What I have learned is that it is important to take autonomy into consideration within the design. The opportunity to choose, gives the users the change to adapt specific aspects to their own wishes which the product/service feels more unique.

Current Situation

Overall Vision

Chiara Treglia I have always been confident and enthusiastic about the opportunities given by technology and its application. However, in almost two years of Industrial Design studies I learned that, while designing, usually there is a certain tendency to be naively optimistic about its effectiveness yet its feasibility, in terms of costs and benefits. This project brought us to think about technological applications in an innovative yet down to earth way, by means of existing technological tools that combined, could lead to a disruptive concept. I have mainly been working on the concept development, especially as far as it concerns the procedure, in order to link the digital platform and the physical experience at the vaccination event. I have been responsible to conduct scientific research and I am happy that major insights have been used in the conceptualization phase. Besides, while working on a concrete case as the vaccination event, where different stakeholders and users are strictly involved and related to each other, I developed my capabilities of systemic thinking. By applying abstraction skills, I could give input in realizing an intelligent system that would have major positive outcomes for healthcare, by optimizing and improving the vaccination procedure. I really enjoyed working on this project because it allowed me to think and see the design context as a dynamic environment, in which different agents influence, exchange information and interact with each other. I felt our role as designers not anymore just as mere inventors of new items, rather as those who see the â&#x20AC;&#x153;big pictureâ&#x20AC;? and due to this global vision, are responsible to come up with a solution that could truly make a positive impact on peopleâ&#x20AC;&#x2122; lives.

Acknowledgements Firstly we would like the thank Roy for his support, inspiration and guidance throughout our project. Your knowledge of healthcare has been very helpful, especially during the research phase of our project.. Secondly, we would like to thank Caroline van Duygan - van Moorsel, Advisor of Innovation GGDBZO, who gave us valuable and constructive feedback and supported us throughout the whole design process. Working alongside you throughout this project has been both helpful and inspiring.You have provided us with useful information and contacts which have proven to be very beneficial to our project. In addition, we would also like to thank Annemiek Brugman for your helpful insights. The observations and information you provided us were very important for our design process and research.

Overall Vision

References

Overall Vision

[1] gezondheid en zorg in cijfers CBS http://www.rivm. nl/en/Documents_and_publications/Common_ and_Pres ent/Ne wsmess ages/2014/Average_ participation_in_the_National_Immunisation_ Programme_in_the_Netherlands_around_95]

Figure 8: Made or designed by our team

Figure 1: ht t p s : / / w w w. g o o g l e . n l / s e a r c h ? q = v a c c i n a tion&rlz=1C1CHWA_itIT593IT593&espv=2&biw = 1 6 0 0 & b i h = 7 6 7 & s i t e = w e b hp & s o u r c e = l nms&tbm=isch&sa=X&ved=0ahUKEwi8pcSS1ZLKAhXIoA4KHWnmACMQ_AUIBigB#tbs=sur:fc&tbm=isch&q=vaccines&imgrc=5UKAvlntUh1vDM%3A

Figure 9: Made or designed by our team Figure 10: Made or designed by our team Figure 11: Made or designed by our team Figure 12: Made or designed by our team Figure 13: Made or designed by our team Figure 14: Made or designed by our team Figure 15: Made or designed by our team

Figure 2: Made or designed by our team

Figure 16: Made or designed by our team

Figure 3: Made or designed by our team

Figure 17: Made or designed by our team

Figure 4: http://zesdeziekte.nu/waarom-vaccinatie-voor-kinderen/

Figure 18: Made or designed by our team

Figure 5: http://www.practicalpainmanagement.com/pain/ acute/history-pain-nature-pain

Figure 20: Made or designed by our team

Figure 6: http://www.practicalpainmanagement.com/pain/ acute/history-pain-nature-pain

Figure 22: Made or designed by our team

Figure 7: Recreated by our team, with reference from: Veerkamp JSJ, Majstorovic M.Angst voor tandheelkundige behandeling en naaldangst bij kinderen, Een verband? NederelandsTijdschrift Tandheelkdunde 2006; volume 113: pages 226-229

Figure 24: Made or designed by our team

Inadequate Pain Management During Routine Childhood Immunizations: The Nerve of It. AnnaTaddio, MSc, PhD, RPh1,2; Christine T. Chambers, PhD, RPsych3,4

Figure 19: Made or designed by our team

Figure 21: Made or designed by our team

Figure 23: Made or designed by our team

Figure 25: Made or designed by our team Figure 26: http://www.helmond.nl/BIS/2015/Notities%20 en%20kaarten/Raadsnotities/RN%20057%20 GGD%20Brabant%20Zuidoost%20Jaarrekening%20 2014.pdf

Appendix Digital Application Pages: To experience a prototype of our first interactive application, go to: https://drive.google.com/drive/u/0/ folders/0B0xvIcJO6LxJY0RQMTdC QmdSS1k However, this prototype will only be public online for a few days, so you are able to download it. But after a few days it will be made private again. If you wish to download it after it is public then please contact us on l.e.power@student.tue.nl

Letter from E.I. Schipper:

Vaccination Information Brochure

Observations Pictures

Research Plan Honors Team Ouch Team: Vera Henricks, TU/e 2nd year Bachelor Chemical Engineering student v.c.henricks@student.tue.nl Chiara Treglia, TU/e 2nd year Bachelor Industrial Design student c.treglia@student.tue.nl Laura Power, TU/e 2nd year Bachelor Industrial Design student l.e.power@student.tue.nl Jolijn van Sleeuwen, TU/e 2nd year Bachelor Industrial Design student j.j.m.v.sleeuwen@student.tue.nl Contact person: Jolijn van Sleeuwen j.j.m.v.sleeuwen@student.tue.nl +31 6 43637931 Coaches: ir. Roy van den Heuvel Researcher at department of Industrial Design, TU/e R.v.d.Heuvel@tue.nl Caroline Duygunvan Moorsel, GGD, Adviseur Innovatie C.Duygun@ggdbzo.nl