Jo van Engelen

Designing new and inclusive diagnostic tools to detect Neglected Tropical Diseases (NTDs) to achieve rational disease control requires a co-design process where end-users’ input is important. Failure to involve all potential end-users in new diagnostics for NTDs can result in low use and adoption failure, leading to persistent infection hot spots and ineffective disease control. There are different categories of potential end-users of new diagnostic tools for NTD control, and it is unclear if there are differences between the user efficiency, effectiveness, perception, and acceptability across these end-user categories. This study evaluated the usability, user perception, contextual factors affecting the user’s experience, and acceptability of a new digital optical diagnostic device for NTDs across three types of potential end users. A total of 21 participants were tested. Laboratory scientists, technicians, and Community Health Extension Workers (CHEWs) in training achieved similar scores on the usability and user perception questionnaires with no statistically significant difference between end-user categories. All participants also have high scores for the user perception domains which strongly correlate with the acceptability of the AiDx NTDx Assist device. This study indicates that, by providing digital diagnostic tools in combination with minimal training and support, CHEWs undergoing training and, by extension, CHEWs post-training, can be involved in the diagnoses of NTDs, potentially enhancing a community’s capabilities to diagnose, treat, and control NTDs.

Schistosomiasis is one of the Neglected Tropical Diseases that affects over 200 million people worldwide, of which 29 million people in Nigeria. The principal strategy for schistosomiasis in Nigeria is a control and elimination program which comprises a school-based Mass Drug Administration (MDA) with limitations of high re-infection rates and the exclusion of high-risk populations. The World Health Organization (WHO) recommends guided case management of schistosomiasis (diagnostic tests or symptom-based detection plus treatment) at the Primary Health Care (PHC) level to ensure more comprehensive morbidity control. However, these require experienced personnel with sufficient knowledge of symptoms and functioning laboratory equipment. Little is known about where, by whom and how diagnosis is performed at health facilities within the case management of schistosomiasis in Nigeria. Furthermore, there is a paucity of information on patients’ health-seeking behaviour from the onset of disease symptoms until a cure is obtained. In this study, we describe both perspectives in Oyo state, Nigeria and address the barriers using adapted health-seeking stages and access framework. The opportunities for improving case management were identified, such as a prevalence study of high-risk groups, community education and screening, enhancing diagnostic capacity at the PHC through point-of-care diagnostics and strengthening the capability of health workers.

For the transition toward a circular economy, it is essential that products are returned for reuse, refurbishing or recycling. In order to address the lack of literature on the topic from a user perspective, this paper explores how users can be stimulated to return used smartphones. Taking a Research through Design approach, we developed a novel set of “design for divestment” principles. Divestment is the process users experience when separating from a product. After introducing a conceptual model of divestment based on an extension of the Consumer Decision Process model by Blackwell, Engel, and Miniard, we describe seven empirical studies (i.e., design projects) into smartphone divestment. The studies explore factors that influence a successful divestment process. We report on a highly complex process with interrelated factors changing over time. While it is impossible to define a blueprint for an ideal divestment process, several patterns emerged such as the need to emotionally support users, to give them confidence regarding data security, and to provide information at the right moment. These unique insights contribute to consumer research (i.e., circular consumption); and by translating the insights to ten design principles for divestment, a novel contribution is made to the field of design research.

Value creation in a circular economy is based on products being returned after use. In the case of smartphones, most are never returned and tend to be kept in drawers. Smartphone access services (e.g., leasing or upgrade) have been experimented with in the Netherlands but have been largely unsuccessful. This study explores the reasons why consumers rejected these access-based smartphone services and is one of the very few to address this topic. The findings are compared with the case of car access services, which are socially better accepted, to identify potential areas for improvement. The qualitative study consists of in-depth interviews with consumers (n = 18) who either adopted and used a smartphone or car access service, or had considered a new smartphone or car but did not choose access-based consumption. The findings of this small-scale study suggest that the main reasons for the rejection of smartphone access services are a lack of awareness, misunderstanding of terms and conditions, and unsatisfactory compensation for their sacrifice of not owning. Smartphone access providers could thus clearly communicate customers’ rights and responsibilities, offer an excellent service experience (especially during repair) by taking over the burdens of ownership, and stimulate the societal logic shift from ownership to access.

Millions of people worldwide die prematurely or suffer from severe health ailments due to cooking equipment that causes unhealthy doses of (household) air pollution. Many attempts to address this have fallen short because technology was not improved sufficiently or the way it was introduced constituted an ill fit with the broader “cooking eco-system”. In terms of technology, (biomass) gasifier stoves look promising on all three sustainability dimensions (people, planet, profit) but have not been adopted on a substantial scale across cultures and regions either. We therefore used a design approach that takes multiple contexts (target groups) into account and compared the performance of a gasifier stove that was developed following this multi-context approach with four previous gasifier versions. With the comparative assessment using criteria well beyond mere technological performance we found that it performed better than these versions as well as than what could be expected based on historical learning, while providing additional systemic advantages. These results encourage verification of the value of the multi-context approach in more settings while providing clues for refinement of the assessment method.