Improving the return rate of a smart pillbox in a circular economy

Improving the return rate of a smart pillbox in a circular economy Master Thesis By Yifeng Mao Integrated Product Design From product redesign to comprehensive guidelines 32 Acknowledgements Improving the return rate of a smart pillbox in a circular economy From product redesign to comprehensive guidelines Master Thesis Yifeng Mao MSc. Integrated Product Design Faculty of Industrial Design Engineering Delft University of Technology Graduation Committee Chair | Dr. Jeremy Faludi Faculty of Industrial Design Engineering - Circular Product Design Mentor | MSc. Tamara Hoveling Faculty of Industrial Design Engineering - Design for Sustainability Faculty of Industrial Design Engineering Delft University of Technology Landbergstraat 15, 2628CE Delft the Netherlands Digital Health in the Circular Economy (DiCE project) https://circulardigitalhealth.eu/ Over the course of this project, I have delved deeply into its intricacies and challenges. The fruition of this endeavor owes much to the invaluable contributions and guidance of numerous individuals. I extend my profound gratitude to my supervisory committee, Prof. Jeremy Faludi and MSc. Tamara Hoveling. Prof. Faludi's meticulous attention to detail and unwavering commitment ensured the project's direction and momentum. MSc. Hoveling's consistent support and direction were instrumental, especially during moments of uncertainty. My appreciation extends to Suzanne Tholenaar from Games for Health, whose expertise enriched my understanding of nudging and provided a clearer perspective on our target demographic. I am also indebted to my fellow designers, whose collaborative spirit and creativity were pivotal in shaping the project's trajectory. Lastly, to all who have bolstered me both personally and professionally, enabling my dedication to this project, I express my heartfelt thanks. 54 Abstract This study explores nudging strategies to improve user abilities in order to promote the voluntary return of digital health products, with a focus on the smart pillbox. The two objectives were to create specific design recommendations for the smart pillbox and derive general design guidelines to support a circular lifecycle for future digital health innovations. The study revealed four key design aims: enhancing user abilities, establishing reliable return mechanisms, reducing participation barriers and exploring the wide range of potential applications. The investigation combined thorough analysis, engaging users and refining designs through iterations. The key findings emphasized the crucial factors of product hardware design and strategic communication in influencing users' abilities and willingness to return the smart pillboxes. Innovations in designing smart pillboxes, such as state switches, clear printed instructions, and digital reminders, have been introduced. Preliminary validations suggest that they are effective, but there is a need for further research to explore their combined impacts. Interestingly, this research highlights the importance of "Returners" as crucial stakeholders in the product return ecosystem. This underscores the need for tailored comprehension and design to meet their unique requirements. Although the recommended guidelines have the potential to benefit a wider range of smart health devices, it is essential to validate them with more extensive participant groups. It is worth noting that the current research mostly focused on user ability, however, future studies are encouraged to explore the motivation dimension, which participants identify as a critical factor. This would help create a holistic approach to encourage voluntary product returns. 76 Abbreviation CE Circular Economy DiCE Digital Health in the Circular Economy EoL End of Life EU-MDR European Union Medical Device Regulation FBM Fogg’s Behaviour Model IoT Internet of Things LCA Life Cycle Assessment PCB Printed Circuit Board R&D Research and Development SMS Short Message Service Glossary Collection: The process or system set up to collect and accumulate a particular type of equipment. In the context of this report, it refers to the collection of returned pillboxes or devices. Divestment: The act of selling or disposing of assets, especially in a planned manner. In the context of the product lifecycle, it can refer to users parting with their equipment, either through return or other means. End-of-Life (EoL): Refers to the final stage of a product's lifecycle, indicating that the product has reached the end of its useful life. At this point, it's no longer suitable for regular use and is ready to be discarded, recycled or reused. Medication adherence: The degree to which a patient consistently follows the prescribed dosage, timing and frequency of a medication regimen. This can be critical to the effectiveness of treatments and overall health outcomes. Return: The process of giving back or sending a product to its place of purchase or manufacturer, especially for reasons of defectiveness, dissatisfaction or a structured recall system. Returner: An individual or organisation responsible for the act of returning products to their place of purchase or to the manufacturer. In this report, this term could refer specifically to those returning the pillboxes. Reverse Logistics: The process and operations associated with the return of products from their final destination to recover value or ensure proper disposal. Unlike traditional logistics, it involves operations from the end user back to the manufacturer or similar location. 98 Table of Contents Acknowledgements 3 Abstract 4 Abbreviation 6 Glossary 7 Introduction 12 1.1. Project Context 14 1.1.1. Circular Economy 14 1.1.2. Context: DiCE Project 14 1.1.3. The smart pillbox 15 1.2. Background Research 16 1.2.1. Drivers and barriers in the system 16 1.2.2. Behaviour changes and nudging strategies 20 1.2.3. Exploratory Research 22 1.3. Project Objectives 24 1.3.1. Project Scope 24 1.4. Conclusion 26 Approach & Method 28 2.1. Design Process 30 2.2. Methods 32 2.2.1. Literature research 32 2.2.2. Reverse engineering 32 2.2.3. Expert interviews 32 2.2.4. Journey mapping 34 2.2.5. Stakeholder analysis 34 2.2.6. Inspiring design mapping 35 2.2.7. Questionnaire & user interview 36 2.2.8. Co-Creation Session 37 2.2.9. Concept selection 38 2.2.10.Concept Validation 40 Product Analysis 42 3.1. Product Details 44 3.1.1. Customer Journey Map 44 3.1.2. Hardware 46 3.1.3. Software 48 3.2. Flow Model 48 3.3.UserProfile 50 3.3.1. Main User 50 3.3.2. Returner 50 3.3.3. Stakeholders 52 3.4. Conclusion 54 Design Brief 56 4.1. Summary of Problem 58 4.1.1. Design Challenge 58 4.2. Return Scenarios 59 4.2.1. Scenario 1: Pillbox User 59 4.2.2. Scenario 2: Returner 59 4.3. Design Aims 60 Design Development 62 5.1. Exploration 64 5.1.1. Exploratory user test 66 5.1.2. How Might We (HMW) questions 68 5.2. Preliminary ideas 70 5.3. Co-creation Session 72 5.3.1. Findings 73 5.3.2. Design insights 74 5.4. Design Concepts 76 5.4.1. Concept A: Integrated return envelope 76 5.4.2. Concept B: Photo charm and folded return manual 77 5.4.3. Concept C: Direct instruction and text message 78 5.4.4. Concept D: A switch for return mode 79 5.5. Concept Selection 80 5.5.1. Results 81 5.5.2. Findings about design elements 84 5.5.3. Design insights 88 5.6. Redesign Recommendation 90 5.6.1. Features for improving return 90 5.6.2. Example of application 92 5.6.3. Return Journey Proposal 96 5.6.4. Prototype 100 1110 5.7. Design Guidelines 102 5.8. Conclusion 105 Evaluation 106 6.1. Concept Validation 108 6.1.1. Results 109 6.1.2. Conclusion 113 6.2. Impact on material and lifecycle 114 6.3. Limitations 115 6.3.1. Limitations in design features 115 6.3.2. Limitations in design process 115 Conclusion 116 7.1. Project summary 118 7.2. Challenges & Opportunities 118 7.3. Implications 119 7.4. Recommendations 120 7.4.1. Product design 120 7.4.2. Returner 120 7.4.3. Comprehensive Guidelines 120 7.4.4. Motivation 120 References 122 Appendix - A 128 Appendix - B 130 Appendix - C 132 Appendix - D 134 Appendix - E 136 Appendix - F 138 Appendix - F 140 Appendix - G 142 13 Chapter 1 Introduction Project Context Background Research Project Objectives Conclusion This chapter provides an overview of the project by explaining its connection to the circular economy and the end-of-life return of smart pillboxes. It also introduces the results of the background and exploratory research conducted during the primary phase of this project. This encompasses the drivers and barriers in the system for returning and collecting smart healthcare-related devices, as well as the challenges that users face when returning such devices. Ultimately, this chapter defines the objectives and scope of the project. Introduction Improving the return rate of a smart pillbox in a circular economy 1514 1.1. Project Context Waste generation in the healthcare industry is enormous, and existing circular medical products present various challenges, including value, hygiene, requirements, and organizational support structures. (Kandasamy et al., 2022) Healthcare is a resource-intensive and essential system that provides well-being for this and future generations. In addition to non-hazardous wastes, many different types of hazardous wastes are generated, including bodily fluids, infectious waste, pharmaceuticals, sharps, and e-waste from equipment. (Moultrie et al., 2015) The medical device industry leads to a high environmental footprint while maintaining essential social functions (Guzzo et al., 2020). Identifying opportunities for innovation in the circular life cycle of a variety of equipment is therefore challenging. 1.1.1. Circular Economy A circular economy is an economic system based on the systematic application of strategies to slow, close, or shrink the material and energy cycles to achieve a sustainable future. (Kirchherr et al., 2017). As demonstrated in Figure 1, the World Economic Forum (2014) outlined pathways in which technical materials and value can be returned to users or systems in a circular economy, including maintenance, reuse/redistribution, refurbishment/ remanufacturing, and recycling. Regardless of the value recovery pathway, the value and the material need to be collected from end users back to the system. This is reflected in the acquisition and collection of used products during the product journey. By overcoming the challenges of product return and collection, circular economy business models can be implemented more successfully (Kirchherr et al. 2017). 1.1.2. Context: DiCE Project The Digital Health in Circular Economy (DiCE) project takes a comprehensive approach to the growing challenge of digital health waste (Digital Health in the Circular Economy 2023). It encompasses all stages of the lifecycle of a digital health device, from inception to disposal, with a focus on extending the life of Figure 1 Butterfly diagram (Ellen MacArthur Foundation, 2019) the product. DiCE emphasises the importance of robust testing and implementation of endof-life strategies that incorporate cutting-edge refurbishment, remanufacturing, and recycling technologies. These methods aim to optimise the recovery of products, components, and materials when reuse isn't an option. Ultimately, DiCE advocates a shift from a disjointed, linear model to a sustainable, circular one that promotes product reuse and component and material recovery. In terms of DiCE's mission, this design project, using smart pillboxes as an entry point, primarily addresses the reverse logistics aspect to increase the return rate of devices for refurbishment or remanufacturing. 1.1.3. The smart pillbox A smart pillbox is selected as one of the four products under investigation in the DiCE project. As represented in Figure 2, designed to streamline medication management, it syncs with a mobile application, leveraging integrated technology to facilitate medication adherence. It prompts users to take their medication, provides dosage instructions, and tracks compliance, thereby making the task of managing medication more straightforward. The primary materials of the pillbox are polycarbonate, while it features a rechargeable lithium battery, a printed circuit board, and a speaker. The packaging includes a charging adapter and a power cord. By employing a robust return and collection program, vital components and materials of the pillbox can be recycled and reused, effectively reducing the environmental impact. A smart pillbox can be characterised as a 'borderline medical device' (Medicines and Healthcare products Regulatory Agency, 2021). This underlines its multifaceted nature and the complexity involved in its categorisation. "Borderline medical devices have a clear health-related function but do not meet the conventional definition of a "medical device" within the parameters of the EU-MDR (Publications Office, 2017). Such a position is advantageous for products such as smart pillboxes, as it allows for a more streamlined transition to a circular economy without the burden of strict regulatory compliance face. Such a position is beneficial for products such as smart pillboxes, as it allows for a more streamlined transition to a circular economy without the burden of strict regulatory compliance that these medical devices face. Figure 2 A representation of a smart pillbox & accompanying App Introduction Improving the return rate of a smart pillbox in a circular economy 1716 1.2. Background Research In order to fully understand the context of the project, background research was conducted at a systems level, focusing on the implementation of circular economy and remanufacturing in industry. This included an examination of the barriers and challenges to the widespread adoption and application of circular economy and remanufacturing principles. At the same time, an exploratory study was conducted at the user level to understand the mindset that drives end-of-life (EoL) product returns during their journey, as well as the challenges encountered throughout the returns process. This research also included an exploration of nudging strategies as a potential tool to inform and influence subsequent design directions. 1.2.1. Drivers and barriers in the system Drivers and infrastructures For manufacturers and stakeholders across the supply chain, the adoption of a circular economy requires incentives for participation. According to Aloini et al. (2020), the driving factors can be categorized into seven dimensions: institutional, economic, environmental, organisational, social, supply chain, and technological. Through the literature review, a total of 12 driving factors were identified, including decision-making drivers and infrastructure required. Table 1 shows the details of these 12 driving factors. There are many different types of factors and infrastructures that can drive companies into the remanufacturing cycle. The most influential drivers appear to be institutional and economic. Social factors such as consumer awareness and market competition play an increasing role and are positively correlated with firm size (Aloini et al., 2020). From an R&D and production perspective, efficient supply chain management capabilities and the integration of circular design in the R&D phase may be fundamental to the functioning of the remanufacturing cycle. The unstable flow of critical parts and materials in the remanufacturing cycle poses a challenge to the manufacturing supply chain. Effective management of reverse networks and adaptation to the structure of the supply market can help companies maintain stable production and costs. Lean manufacturing's low inventory levels and ability to adjust production on the fly also contribute to cost control (Ciliberto et al., 2021). At the same time, taking into consideration remanufacturing requirements during the product development phase and adapting remanufacturing strategies during production will be one of the necessary enablers for the manufacturer of the pillbox to move towards a circular economy. User studies have shown that an efficient collection strategy reduces the difficulty of collection for users while increasing their willingness to collect, thus ensuring that critical parts and materials are returned to the system. An efficient collection strategy can therefore be described as a necessary infrastructure for the remanufacturing cycle. Finally, according to Aloini et al. (2020), the impact of the drivers may also depend largely on the particular environment involved, in this case the marginal medical device industry. Therefore, the specific impact of the driving factors mentioned in the research results on the industry still needs in-depth research to verify. Dimension Driving factors References Institutional Government Regulation: policies, laws, directives, regulations, standards, and requirements set by organisations. (Dijkstra et al., 2020); (Prieto-Sandoval et al., 2018); (Tura et al., 2019) Incentives: Tax rebates, funds, low-interest loans, subsidies, incentives, etc. (Dijkstra et al., 2020); (Prieto-Sandoval et al., 2018); Economic Potential to improve cost efficiency and profitability: higher profitability brought about by saving transportation costs, efficient use and recovery of resources, cost reduction and resource recycling, reduced dependence on imports of raw materials, and the impact of fluctuations in resource prices. (Prieto-Sandoval et al., 2018); (Guzzo et al., 2020); (Dijkstra et al., 2020); (Agyemang et al., 2019) Potential for new business development and innovation: Create new value, develop new products, or enter new markets. (Tura et al., 2019); (Dijkstra et al., 2020) Environmental Environmental problems: climate change, energy shortage, resource scarcity, environmental security, and resource limitation. (Tura et al., 2019); (Govindan & Hasanagic, 2018); (Dijkstra et al., 2020) Organizational Strategical concerns: brand reputation and social responsibility (Prieto-Sandoval et al., 2018); (Tura et al., 2019); (Govindan & Hasanagic, 2018); (Dijkstra et al., 2020) Circular Strategies: Efficient collection, inspection, and triage strategy to identify and recover the value. (Tura et al., 2019); (Bocken et al., 2016); (Dijkstra et al., 2020) Social Circular Economy awareness: Stress from the market for green practices from competitors; Environmental awareness, shifting consumer preferences. (Prieto-Sandoval et al., 2018); (Govindan & Hasanagic, 2018); (Dijkstra et al., 2020) Supply Chain Supply configuration: management of reverse network, supply market structure. (Prieto-Sandoval et al., 2018); (Tura et al., 2019); (Dijkstra et al., 2020) Reprocessing system: Cleaning, sterilization, and disinfection processes to ensure the hygiene and safety of remanufactured products. (MacNeill et al., 2020); (Kane et al., 2018) Lean Manufacturing: Reduce inventory, just-intime manufacturing, and modification; Integration of circularity in the design phase. (Ciliberto et al., 2021); Technological information and communication technology: The use of IoT, RFID and other technologies to assist the collection of information tracking and supply management (Tura et al., 2019); (Mathews & Tan, 2011) Table 1 Driving factors in the system. Approach & Method Improving the return rate of a smart pillbox in a circular economy 3130 2.1. Design Process The design process of this project is shown in Figure 5. It provides a comprehensive view of the project's design process, modelled on the principles of the agile design approach. Agile design was well suited to this project because of its iterative nature and rapid feedback loops. The process was organised into a series of 'sprints', each dedicated to a specific aspect of the design. Each sprint in the design phase included a cycle of design and testing. The iterative nature of this process allowed for continuous improvement of design concepts, resulting in refined solutions over time. The results of one sprint, including design challenges and insights, were seamlessly integrated into the following sprint, ensuring a continuous feedback loop and informed progress. This approach fostered a dynamic process that was responsive to emerging insights and adaptable to evolving design requirements. By adopting this Agile-inspired design process, the project was able to efficiently generate, evaluate and refine design concepts, ultimately leading to a more user-centric solution. Figure 5 Overview of design process In order to achieve the primary objective, the project first examined the smart pillbox, and the context of end-of-life (EoL) returns in a circular economy, setting the stage for defining the design problem. Once the problem was identified, an in-depth exploration of the key variables influencing the user experience during the EoL return process was conducted, uncovering the main reasons for non-return and the difficulties experienced during the process. These findings helped to identify the design challenges related to user capabilities during the return process. To address these challenges, preliminary design ideas were generated to stimulate feedback aimed at uncovering user preferences and innovative ideas from participants during co-creation sessions. These ideas were then refined into design concepts and feedback was sought from target users for further development, ultimately leading to the final redesign of the pillbox to improve return rates. Finally, insights from each stage of the project were distilled into a comprehensive guideline for the future design of borderline medical products, paving the way for more circular solutions. Approach & Method Improving the return rate of a smart pillbox in a circular economy 3332 2.2. Methods The research and design methods applied during the project are listed in Table 4. 2.2.1. Literature research The aim of the literature research was to identify the product flow in the collection and remanufacturing system and to discover the drivers and barriers within it. The research process covered 25 pieces of literature in the relevant fields, focusing on identifying the necessary and potential stakeholders in the collection and remanufacturing cycle, their existing and required capabilities, and the motivations and triggers that could encourage their participation. 2.2.2. Reverse engineering Reverse engineering was used in the redesign of the smart pillbox to gain a comprehensive understanding of its existing structure, functionality, and user interaction. This approach provided important insights into its adaptability to the circular lifecycle. In addition, reverse engineering allowed the successful elements of the original design to be retained while innovating where necessary, facilitating a balance between familiarity and improvement during the redesign process. 2.2.3. Exper t inter views Expert interviews, which provided deep insight and domain expertise, were valuable in the product analysis and redesign process. A professional from the anonymous pillbox manufacturer provided a wealth of information about the current systems, strategies and users. An expert from a design organisation shed light on the applied health games landscape and shared insights from the 'Nudgingthon', a series of co-creation sessions aimed at improving the circularity of healthcare devices across Europe. This provided valuable perspectives on incorporating nudging values to encourage user participation in the circular economy. The Business Development Officer from a company specialising in smart collection systems, provided insights into the current landscape of smart collection technology, which is essential for the pillbox’s return and collection process. Overall, these expert interviews enriched the understanding of the pillbox and its broader context and highlighted meaningful directions for innovation and improvement. Method Stages Research Aim Output Literature research Preliminary Research To identify the product flow in the collection and remanufacturing system and to discover the drivers and barriers within it. Lists of drivers and barriers Reverse Engineering Product Analysis To understand the function structure of the pillbox and the app and identify the opportunities. Product disassembly Interface flowchart Expert interview Product Analysis User Research & Scenario Definition To understand the system around the pillbox and how it flows in the system between hospital, user, and manufacturer. To find out about the collection strategies, and the implement of nudging strategies. Flow model Nudging ideas Journey mapping Product Analysis Ideation To systematically dissect and evaluate user interactions with the pillbox, shedding light on actions, decisions, and feelings at each stage. Customer journey map Stakeholder Analysis Product Analysis To understand the stakeholders within the context, especially the possible returner. To find out about what are their goals and abilities. Goals & abilities Stakeholder map Inspiring Design Mapping User Research & Scenario Definition To generate some brainstorming ideas to identify the variable that can be addressed with the nudging design for the user testing. Nudging ideas Return process variants Questionnaire & user interview User Research & Scenario Definition To ascertain and analyse the key variables that exert a positive influence on fostering return intentions. Design challenge Return scenarios Co-creation Ideation To derive evaluations and propositions from user interactions, influenced by their individual capabilities and experiences, in order to uncover user preferences and innovative ideas for the return process. Design insights on improving user’s ability of return. Concept selection Evaluation & Iteration To facilitate the selection of design concepts and gather feedback for further enhancement. The selected design concept for development. Design insights on improving user’s ability of return. Concept validation Detailed Design To validate the effectiveness of the design features in increasing the ability of users to participate in the return and to evaluate how well the design achieves each design objective. Summary and recommendations for future implementation Table 4 Design methods involved in this project. Approach & Method Improving the return rate of a smart pillbox in a circular economy 3534 2.2.4. Journey mapping Journey mapping serves as a powerful tool during the product analysis phase, meticulously dissecting and evaluating the totality of user interactions with the pillbox. This method systematically defines the stages of a user's journey with the product, creating a coherent roadmap of the user experience. It helps to gain insight into the user's actions, the decisions they make and, crucially, the feelings they experience at each stage of the journey. Such a comprehensive view not only illuminates the direct touchpoints, but also highlights potential areas for nudging opportunities, ensuring that design decisions are firmly rooted in the user's experience and needs. 2.2.5. Stakeholder analysis Stakeholder analysis was an integral part of the product analysis phase and aimed to provide a thorough understanding of the various entities involved in the context, in particular the potential returners of the pillbox. This method is central to identifying and assessing the importance of key individuals, groups or institutions that can significantly influence the outcome of the project. Specifically, the analysis was tailored to elucidate the objectives and abilities of each stakeholder in relation to the product lifecycle. The culmination of this assessment resulted in two primary outputs: a delineation of the goals and capabilities for each stakeholder, and a comprehensive stakeholder map that visually represented the relationships and importance of each entity in the context of the product's lifecycle. Figure 6 Design with Intent Tool 2.2.6. Inspiring design mapping Inspiring Design Mapping, using the Design with Intent toolkit (Lockton et al., 2010), is a method that facilitates idea generation and mapping in the context of the pillbox’s return process. Design with intent toolkits provides strategies to influence behaviour through design by considering the interplay between the user, the product and the environment. It stimulates brainstorming sessions and encourages innovation and diversity of ideas. As demonstrated in Figure 6, through the architectural, error-proofing, persuasive, visual, cognitive, and security lenses, it helped generate creative ideas for nudging the users and returners to return the pillbox along the product journey. The process also helps to identify key design elements that impact the return process, allowing for a more focused approach to the redesign of it. The combination of creativity and systematic analysis embedded in this method makes it a powerful tool for the redesign project. Approach & Method Improving the return rate of a smart pillbox in a circular economy 3736 Research questions: • What are the key variables that negatively/ positively influence the fostering of return intentions? Participants The age group and background information about return experience of the participants in this session are shown in Table 5. Materials • Return process variants differ based on six distinct variables. • Questionnaires Research setup 1. The process began with participants being introduced, the concept of mail-back, and smart collection methods. 2. Participants were then asked in the questionnaires about their previous return experiences. If they had any, they were asked a series of questions related to those experiences. If not, they were asked about the reasons why they had not initiated a return. 3. Next, participants were exposed to the existing pillbox return process and four alternative return processes that differed in six different aspects. These were compared in pairs to encourage participants to identify the factors they considered valuable in the return process. 4. Participants were then asked to select the top three factors out of ten that they considered most valuable in the return process. 5. Finally, the researchers offered participants the opportunity to participate in voluntary one-on-one interviews, which provided a deeper insight into their individual perspectives. Number of participants Age group Experience in return/recycling electronic devices 18-24 25-34 35+ Yes No 24 10 11 3 16 9 Table 5 Participants for questionnaires and interview. 2.2.7. Questionnaire & user interview 2.2.8. Co-Creation Session Research questions: • How do users' perceptions of the difficulty of returning the smart pillbox at EoL vary across different return channels? • What information delivery strategies are most effective in improving user understanding and learning of the return process? • What are the preferred approaches to address the need for privacy and security? • What additional elements or methods could potentially enhance the promotion of the EoL return of the smart pillbox? Participants Table 6 shows information about the participants in this co-creation session. Their background in design and as users of the smart pillbox was very helpful in this session. Materials • A smart pillbox • A solution matrix includes six design ideas in two return channels (sketches) Research setup 1. Free Exploration: Initially, participants were accorded the freedom to familiarize themselves with the product and its inherent features, fostering an understanding of the product in an unstructured environment. 2. Introduction: Following this, an overview of the product's context was articulated, alongside a detailed description of the scenario under investigation. 3. Preliminary Concepts: Participants were presented with six different initial concepts from the two design directions, each of which could correspond to both mailback and collection point recall, and their feedback was actively sought. The aim of this interaction was to measure the different design elements, compare the two return methods and identify potential areas for improvement. Another aim was to inspire the participants and make them more open-minded about their needs. 4. Requirements Generation: Participants were divided into two groups, tasked with deliberating and outlining their prerequisites for the return process. This exercise aimed to generate a comprehensive set of user-defined requirements. 5. Brainstorming and Design: Each group embarked on a rapid brainstorming and design session, considering the requirements specified by the opposing group. This cross-referencing of requirements aimed to broaden the scope of idea generation and design. 6. Presentation: In the final stage, each group unveiled their ideas, providing and receiving feedback. This interactive segment fostered dialogue between participants, facilitating a deeper understanding of the presented ideas, and promoting a collective refining of the concepts. Participants ID Specialty 1 Smart pillbox user 2Smart pillbox user / UX designer 3 Service designer 4 Service designer 5 UX designer 6 Product designer 7Product Designer (Medical products) Table 6 Participants for co-creation session. Approach & Method Improving the return rate of a smart pillbox in a circular economy 3938 2.2.9. Concept selection Research questions • Which design concept most effectively enhances user comprehension of its return process? • What specific design elements contribute to increased user engagement with its return process? • How does each design concept align with the needs and capabilities of different user groups? Participants Two different groups were recruited for concept selection: a senior group (Table 7) and a junior group (Table 8). The senior group was selected using convenience sampling, prioritising individuals with longterm medication experience due to chronic conditions. Some also had expertise in related fields. The junior group was recruited mainly through voluntary participation. All participants were given detailed information about the study and signed an informed consent form before participating. Materials • Physical prototypes of 4 design concepts • Questionnaires Research setup 1. Introduction: This stage presented an overview of the project's context, elaborating on the functionality of the pillbox, its utilization in daily living, and the acquisition methods available to prospective users. The primary aim was to ground participants in the practical applications and real-world implications of the product. 2. Scenario Construction: Two distinct scenarios were formulated, each catering to a different age group. These scenarios were designed to reflect the varied needs and unique contexts of the respective age groups. 3. Design Exploration: In this phase, participants were encouraged to investigate four distinct design concepts. Following their individual exploration, an explanation of each design concept was provided. This allowed for a comparison of the participants' initial interpretations against the intended design concept. 4. Evaluation: Participants were prompted to evaluate each design concept using a rating scale of 1-7, based on their agreement with ten statements pertaining to product ability and potential usage difficulties. On this scale, 1 signified strong disagreement, whereas 7 indicated strong agreement. This evaluation aimed to capture their personal experiences and views towards the product. 5. Interview: Proceeding from the scores assigned to each statement, participants were asked to elaborate on the reasoning behind their ratings. They were queried about potential enhancements and asked how they might act if they found themselves in the proposed scenarios. This qualitative data aimed to add depth to the numerical evaluations and offer insights into participant thinking. 6. Value Proposition: In the final stage, participants were asked to prioritize eight values associated with ability requirements in the product return process. The objective was to ascertain what participants deemed crucial when deciding whether to follow return instructions. This value-ranking highlighted user priorities and shaped our understanding of their decision-making process. Senior Group You have been using this pillbox for several years to manage your medication, following your doctor's recommendation. This pillbox has served you well, providing reminders and helping you organize your medicines. However, as years passed, your needs have changed. A new medication management product has caught your eye, promising additional features that you find beneficial. You've decided to make the switch, leaving this pillbox redundant. Now, you are faced with the decision of what to do with your no-longer-needed device. Junior Group You're spending a weekend decluttering your house, and during this process, you stumble upon a smart pillbox. This electronic device isn't yours; it belonged to your parents or maybe your grandparents. They used it for years to help manage their medication schedules, but they've since moved on to a different system or maybe no longer require it. You don't know much about the pillbox itself or how it works. But now it's in your hands, and you're left with a decision to make. Now, you are faced with the decision of what to do with this idle device. Scenarios Age Gender Long-term medication experience Product return experience Note 150-55 Female No Yes 255-60 Female Yes Yes 355-60 Female Yes No Physical Therapist 455-60 Male Yes Yes Physical Therapist 565-70 Male Yes No Retired Table 7 Participants for concept selection (Senior group) Table 8 Participants for concept selection (Junior group) Age Gender Long-term medication experience Product return experience 118-24 Female No Yes 218-24 Female No No 318-24 Male No Yes 418-24 Male Yes Yes 525-30 Male No Yes 625-30 Male Yes Yes Approach & Method Improving the return rate of a smart pillbox in a circular economy 4140 2.2.10.Concept Validation Research questions • How well does the design features in combination address each design challenge? • How do the proposed design features of this pillbox overall affect the user’s perception of the difficulty of the return process in 2 different age groups? Participants For the concept validation of the redesign features, two groups were again formed: a senior group (Table 9) and a junior group (Table 10), each consisting of 5 participants. The recruitment methodology mirrored the initial concept selection phase. The senior group was selected using convenience sampling, focusing on those with long-term medication experience and relevant expertise. The junior group relied primarily on voluntary participation. Notably, the majority of participants in the validation phase had also participated in the initial concept selection, ensuring consistency of feedback. All participants were fully informed of the objectives of the study and provided informed consent prior to participation. Materials • The current smart pillbox • Functional prototype that integrates the proposed design features • Questionnaires Research setup 1. Introduction: Provide a detailed overview of the context of the project, highlighting the essential functions and unique features of the pillbox. 2. Understand design challenges: Introduce the participants to the four core aspects of the design challenge: returnability, user confidence, clarity of instructions and convenience in everyday life. Ensure that the participants understand these objectives as they will be an integral part of their evaluation. 3. Existing Experience Walkthrough: Present the current return experience to the participants and virtually walk them through the process. The procedure will vary depending on the participant's role as either a pillbox user or a returner. 4. Initial questionnaire: After the walkthrough, invite participants to complete a questionnaire that explores the four aspects of the design challenge. 5. Redesigned Experience Walkthrough: Present the proposed return experience of the redesigned pillbox. Conduct a virtual step-by-step walkthrough, which will vary depending on whether the participant is a pillbox user or a returner. 6. Follow-up questionnaire: Ask participants to complete a second questionnaire reflecting their experience with the redesigned pillbox. This feedback will be compared with their initial impressions to assess the effectiveness of the redesign. 7. Interviews: Using the scores assigned to each statement in the questionnaires, conduct in-depth interviews with participants to understand the rationale and insights behind their ratings. Age Gender Long-term medication experience Affinity with the postal system 150-55 Female No High 255-60 Female Yes High 355-60 Male Yes Low 455-60 Male Yes Low 565-70 Male Yes High Table 9 Participants for concept validation (Senior group) Age Gender Long-term medication experience (Family member) Affinity with the postal system 118-24 Female Yes High 218-24 Male Yes High 325-30 Female Yes High 425-30 Male Yes High 525-30 Male Yes High Table 10 Participants for concept validation (Junior group) 43 Chapter 3 Product Analysis Product Details Flow Model User Profile Conclusion In addition to the product specifics, this chapter also provides an overview of the user demographics, articulating exactly who interacts with the smart pillbox. Beyond the user, other stakeholders, and their roles within the smart pillbox return process are considered, highlighting the multiplicity of actors involved in this circular lifecycle. In essence, this chapter provides a thorough understanding of the smart pillbox, its users, and other stakeholders, which forms the basis for the subsequent design and analysis. This chapter provides a comprehensive exploration of the smart pillbox. It dissects key aspects such as the user journey, hardware assembly, and software functionality to provide a holistic understanding of the product. It also describes the current product flow within the system, involving the manufacturer, the hospital, and the user. The intricacies of this exchange illuminate the real-world functioning of the smart pillbox. Product Analysis Improving the return rate of a smart pillbox in a circular economy 4544 3.1. Product Details 3.1.1. Customer Journey Map Based on the interviews with the professionals from the anonymous smart pillbox manufacturer, and the users of smart pillboxes, the user journey of a smart pillbox can be depicted in a customer journey map (Figure 7). Patients typically become aware of the pillbox through a doctor's recommendation to improve medication management and adherence. After receiving it, they learn how to use it, including creating an account, setting alarms, and managing medication records. Once set up, users will receive an alarm from the pillbox and a notification from the app at the scheduled medication time. During this time, upon opening the pillbox, the user will notice LED lights corresponding to the compartments containing the medication to be taken. The number of lit LEDs indicates the number of pills to be taken. After taking or skipping their medication, users can respond to the notification in the mobile app and log their medication intake. The app generates a weekly medication adherence report that can be accessed by the user's caregivers and physicians. Regular meetings can be scheduled with their doctors to review and discuss this medication adherence data. As described by the participants in the exploratory research, some users may stop using the pillbox over time for a variety of reasons , including improved health, changing medication needs, switching to a new medication management solution, or even patient mortality. These users may begin to disregard its alarms, either turning them off or simply ignoring them until the battery runs out. When users realise that they no longer want to keep the pillbox, they will need guidance on what to do with the unused pillboxes, which may come from their doctor or directly from the manufacturer. Finally, albeit in limited cases, users return the pillbox to the manufacturer by post. This process happens in the stages of Obsolescence and Divestment, where this project focused on. Figure 7 Current customer journey map of a smart pillbox. Product Analysis Improving the return rate of a smart pillbox in a circular economy 4746 3.1.2. Hardware Throughout the lifecycle of a smart pillbox, different interventions can be applied to the hardware of the smart pillbox to extend its operational life or optimise its EoL impact. Each of these interventions varies in intensity and scope, targeting different components of the pillbox: Repair •Plastic housing: Minor cracks or damage to the housing are sealed or patched without replacing the entire structure. •Core Components: Problems such as loose connections or minor faults in the circuit board are repaired. Faulty batteries may be reconnected or reset if not significantly degraded. Remanufacturing •Plastic housing: Depending on wear and tear, the housing can be completely replaced with a new or recycled plastic mould to ensure structural integrity. •Core Components: Severely degraded batteries are replaced. The PCB can be comprehensively upgraded, replacing obsolete parts and updating software to the latest versions. Recycling •Plastic housings: The plastic is broken down into its basic material, which can be processed and reused to make new products or housings. •Core Components: Batteries are dismantled, and reusable materials are extracted for new production. The PCB is dismantled and valuable metals such as gold, silver and copper are extracted for reuse. Refurbish •Plastic housing: Thoroughly cleaned to remove any stains or residue. Scratches may be polished to restore the original appearance. •Core Components: The battery will be checked for health and, if still functional, fully charged. The hardware of the pillbox can be divided into two main parts: the bottom tray and the top lid, which are connected by protruding latches and bearings on the tray and rail slots on the lid. Magnets in the two parts and a spring in the lid provide damping and limit positioning for the sliding opening and closing of the lid. The representation of a disassembly of a smart pillbox is shown in Figure 8. The lid acts as a housing for the main functional components, which are divided into two sections and connected by snap fingers. Inside, the loudspeaker is connected to the PCB via contact points, while the lithium battery supplies power to the PCB via a connector. The PCB contains a series of LED lights, a touch sensor, a Hall sensor to detect opening and closing, a Bluetooth module and a Micro-USB charging port. These components provide the basic functionality of the smart pillbox, which includes sending alarms, displaying medication position and quantity, detecting the opening and closing of the pillbox to assess medication intake, and synchronising with the app. The ease of assembly makes this pillbox suitable for repair, refurbishment, and remanufacturing . All electronic components, including the PCB, lithium battery and speaker, are housed in the lid. These components have relatively high remanufacturing values and environmental impacts, making the lid the primary target for collection and remanufacturing . Even if the plastic parts are damaged during reverse logistics, they can be recycled back into plastic material and used to make plastic components. Damage to the surface of these pillboxes will not have a significant impact on the remanufacturing value if the core components are not damaged. All electronics are secured to the case by the structure, with the PCB taped securely in place and flush with the top cover. This tape is easily removable and replaceable. Plastic components are joined together with snap-fit fasteners. This screwless assembly allows the pillbox to be disassembled quickly and easily without damage, greatly facilitating subsequent refurbishment or remanufacturing, and simplifying maintenance and repair. Figure 8 A representation of a disassembly of a smart pillbox Product Analysis Improving the return rate of a smart pillbox in a circular economy 4948 3.1.3. Sof tware The accompanying app serves as a critical element of the product ecosystem, providing a platform for programming alarms, logging medication intake and synchronising data with the pillbox to generate comprehensive medication statistics. This enables users, caregivers, and healthcare professionals to effectively monitor medication adherence. In addition, the application enables richer interaction and information sharing between the user and the pillbox, paving the way for advanced user engagement. The capabilities of the app also extend to the potential for implementing nudging strategies, providing a wealth of opportunities for effective communication of return information. At the same time, however, some users stated that they no longer opened the app once their medication settings were complete. They ignored the app's notifications and logging feature while using it. In addition, some users' apps failed to send notifications due to the user's system notification settings. These situations illustrate the risks and drawbacks of relying on the app to communicate return and collection information. 3.2. Flow Model Based on the information gathered from the expert interview with the professional from the anonymous pillbox manufacturer, the product flow between "hospital - patient - manufacturer" is modelled as Figure 9. Under the current system, manufacturers work with hospitals to enable doctors to prescribe the smart pillbox to patients. Once prescribed, patients purchase the device online, which is then delivered by mail. To track patient adherence, manufacturers provide hospitals with back-end access to pillbox's system, including comprehensive data monitoring capabilities. Figure 9 Current product flow of a smart pillbox Conventionally, hospitals do not require the return of these pillboxes after use. However, some hospitals have implemented a depositbased system that requires patients to return the pillboxes to reclaim their deposits. In such scenarios, patients are instructed by the hospitals to send the used pillboxes directly to the manufacturer's address to avoid duplicate shipping. After refurbishment, these pillboxes are either returned to the hospitals or donated to the patients who need them but cannot afford the cost of purchasing new ones. 63 Chapter 5 Design Development Exploration Preliminary Ideas Co-creation Session Design Concepts Concept Selection Redesign Recommendation Design Guidelines evaluated, and refined based on the results of these tests and subsequent feedback. Such insights not only drove the iterative refinement of the redesign of the pillbox, but also contributed to the creation of a comprehensive guideline that could potentially shape future design initiatives within this product category. This chapter provides a detailed exploration of the iterative design process that led to the final conceptual redesign of the smart pillbox. It illustrates the iterative journey of ideation and refinement that took place over several design sprints. Throughout the design and development phase, four distinct testing/cocreation rounds were systematically conducted to inform and steer the design direction. Conceptual ideas were regularly assessed, Design Development Improving the return rate of a smart pillbox in a circular economy 6564 5.1. Exploration Having established the core design objectives of the project, an exploratory test was planned to explore potential directions for redesign. As demonstrated in Figure 11, the Obsolescence and Divestment stages of the customer journey map were zoomed in to the task level and certain factors that potentially influence return intent and perceived difficulty in the process were identified. These identified factors promoted a round of brainstorming to generate ideas that could positively influence users' willingness to participate in the return process. Using inspiring design mapping, introduced in Chapter 2.2.6., about the return process, some initial brainstorm ideas were generated. The ideas were mapped into the existing return prose and categorised according to the aspect of the return process they addressed. In the end, six main variables encompassing the return process were identified and targeted as the key issues to be investigated in this testing phase, including Instruction, Size & shape, Routine, Appearance & presentation, Data privacy, and Transparency. Ideas corresponding to each variable were then refined and combined to form distinct process variants. These were used to stimulate the test participants and to facilitate comparisons of the different levels of importance they attached to each variable. Figure 11 Possible influencing factors in the existing return process. Design Development Improving the return rate of a smart pillbox in a circular economy 6766 5.1.1. Exploratory user test The objective of this research is to ascertain and analyse the main variables that exert a substantial and positive influence on fostering return intentions. As shown in Figure 12, the stimuli used in this test are 4 return process variants differ based on six distinct variables: • Instruction • Size & shape • Routine • Appearance & presentation • Data privacy • Transparency This test consisted of two parts: questionnaires asking participants to reflect on and compare the different variables, and a subsequent conversational interview. Detailed information on the testing process can be found in Chapter 2.2.7. 'Questionnaire & user interview'. Results Lack of relevant information: The main barrier that prevented users from completing the return process, as revealed by the questionnaires and interviews, was a distinct lack of relevant information. Many participants, despite having a strong understanding of healthcare products and a genuine desire for sustainability, felt handicapped by the lack of essential guidance. This deficiency made it difficult for them to identify accurate return channels. Interestingly, even though they saw the return of the product as a social responsibility, their drive was stalled by this information gap. This is consistent with the importance attached to the instruction variable. There's also evidence that the perception of the product's identity can influence return decisions. When the pillbox was perceived as a health device, it was seen as more likely to be returned than when it was perceived as a daily necessity, highlighting the importance of clear product communication. Concerns about privacy and trust: Another significant barrier to returns was related to issues of privacy and trust. Given the sensitive nature of medical devices, participants demonstrated a higher need for security than with standard consumer electronics. This need for trust was underlined by their reluctance to use return channels that they perceived as untrustworthy. The underlying concern was about potential risks to subsequent users if the reliability of the return channel was uncertain. This sentiment is largely consistent with the importance of the 'transparency' variable, indicating an urgent need for transparency in the process. Need for explicit & easy-to-follow instructions: The feedback from the questionnaire showed that among the variables initiated by the return process, instructions were rarely mentioned. This may be due to the fact that the specific steps of the return process were made clear to the participants during the briefing, which may have reduced their perceived need for further instructions. Correspondingly, the relative importance of this is more strongly reflected in the interview results. Return process not fitting into daily routines: The questionnaires indicated that participants valued the integration of the return process into their routine. If a system does not fit effortlessly into a user's daily life, the likelihood of engagement is reduced. The interviewees expressed a clear preference for the location of the return pillboxes, with the preferred locations being those they frequented in their daily lives. This feedback illustrates the importance of making the returns process as seamless as possible for users so that it fits effortlessly into their daily activities. Figure 12 Variants of the return process of a pillbox. Design Development Improving the return rate of a smart pillbox in a circular economy 6968 The results of the user tests highlight key areas for improvement to encourage returns. A closer look at the results reveals four HMW questions that need to be answered in order to promote a viable product return system. The HMW questions and their corresponding barrier and potential solutions are listed in Table 11. Table 11 HMW question and corresponding barriers 5.1.2. How Might We (HMW) questions Barrier HMW Question Potential Design Solution Lack of relevant information How might we make users aware of the returnable property of the product? Provide clear communication about product's return potential. Concerns about privacy and trust How might we build user trust in the returns process? Establish transparent and accountable return procedures. Need for explicit and easy-tofollow instructions How might we provide intuitive instruction and aids to facilitate the return behaviour? Design a step-by-steWp guide or infographicW on the return process. Return process not fitting into daily routine How might we make the return a convenient task that fits the users’ everyday planning? Integrate return channels into daily life, like at local stores or post offices. Design Development Improving the return rate of a smart pillbox in a circular economy 7170 5.2. Preliminary ideas In response to the HMW questions derived from the exploratory user test, several design directions were conceived. One direction is to embed information about the returns process into the natural interactions that users have with the pillbox. This approach aims to leverage touchpoints in the latter part of the product lifecycle where users are likely to engage with return information. For example, return instructions can be strategically introduced when the user, no longer needing the pillbox, decides to clear out the pills or when they are considering disposing of the product. This just-in-time approach to providing information can help to facilitate seamless learning of the return process. It serves a dual purpose: not only does it educate users about the process, but it also demonstrates the product's identity as a circular, returnable healthcare product. This creates a subtle but persistent reminder of the pillbox’s identity throughout the customer journey, encouraging users to make sustainable choices. Another strategy is to embed cues within the product to stimulate curiosity and encourage users, especially returners, to discover the return information on their own. This approach can make users more proactive in learning about the return process and encourage them to follow the return instructions. As an approach to address privacy concerns, a more accessible reset button or feature could be incorporated into the design to allow users to erase their data, thereby increasing their sense of privacy. For integrating the return process into the user's daily routine, the creation of dense collection points was considered. These collection points, ideally located in common places such as supermarkets and pharmacies, could potentially meet users' needs for convenient access. As a result, smart collection machines could be a viable solution. From a logistics perspective, post offices and service points represent additional locations for returning pillboxes, where users could post the item back instead of using smart collection machines. To summarize these design directions, six preliminary design ideas were generated from these directions. These ideas can be organised into a matrix based on how they disseminate return information (X-axis) and how they address privacy issues (Y-axis). Each idea could be adapted to either the smart collection strategy or the postal return method. The matrix and the explanation of the preliminary ideas are illustrated in Figure 13. Figure 13 Solution matrix of preliminary ideas. Design Development Improving the return rate of a smart pillbox in a circular economy 7372 5.3. Co-creation Session The primary objective of this session was to engage participants with a variety of preliminary design ideas with the specific aim of enhancing the return experience of the smart pillbox. Evaluations and propositions derived from user interactions, influenced by their individual capabilities and experiences, were employed to uncover user preferences and innovative ideas for the return process of the pillbox. Having involved its users, design experts, and experts with knowledge in healthcare industry, this session provides insights from their perspective and valuable feedback on the design. The setup and the procedure of this cocreation session can be found in Chapter 2.2.8. "Co-Creation Session". The research questions to be answered in this session were: How do users' perceptions of the difficulty of returning the smart pillbox at EoL vary across different return channels? 1 What information communication strategies are most effective in improving user understanding and learning of the return process? 2 What are the preferred approaches to address the need for privacy and security? 3 What additional elements or methods could potentially enhance the promotion of the EoL return of the smart pillbox? 4 5.3.1. Findings How do users' perceptions of the difficulty of returning the smart pillbox at EoL vary across different return channels? While the postal return approach is perceived as more laborious than smart collection points, it is easier for users to understand and accept. This can be attributed to its alignment with traditional perceptions of product returns. Despite the additional effort required, familiarity with the postal return process might make it seem less daunting. In addition, integrating collection points into everyday locations such as supermarkets and pharmacies presents a unique challenge. While these locations offer convenience, it is difficult to guarantee that every potential location will be able to accommodate the return process. This uncertainty could undermine users' confidence in the success of their return efforts at such locations. In comparison, postal service points offer a more reliable option. These points are usually easy to locate based on the user's location, making them accessible and trustworthy return locations. This convenience, combined with the trusted nature of postal services, can reduce the perceived difficulty, and encourage user participation in the product return process. What information communication strategies are most effective in improving user understanding and learning of the return process? The results showed that simplicity and straightforwardness were paramount in the communication of return information. Strategies such as incorporating cues into the product design were seen as intriguing and interesting. However, it was noted that such cues do not necessarily match the inherent nature of the product and could potentially be triggered or damaged during use. Whilst innovative strategies may stimulate user interest, they need to be balanced with the functionality of the product. What are the preferred approaches to address the need for privacy and security? In addressing privacy concerns, user perspectives may be context dependent. The study found that users may not perceive the data stored in the pillbox as significantly private or personal. They likened it to an alarm set in an alarm clock - a seemingly trivial piece of information. Interestingly, when presented with an option or feature to delete data, users began to take data privacy more seriously and this influenced their intention to return. The presence of such a feature made them think about the potential privacy implications. This suggests a delicate balance in how design features can prompt reconsideration of privacy concerns, which may inadvertently cause users to overthink the issue. What additional elements or methods could potentially enhance the promotion of the EoL return of the smart pillbox? From the user insights, several methods and elements emerged that could potentially enhance the return promotion of the smart pillbox. One critical element identified is timely reminders, not only of the return process itself, but also of the existence of the pillbox. This will prevent the device from being neglected or forgotten at home once it has fulfilled its primary purpose. In addition, participants suggested the use of compelling visuals or slogans to emphasise the benefits and value of the return process. By highlighting the positive environmental impact and the user's contribution to societal wellbeing, these communication strategies could promote greater awareness and contextual understanding of the return process. Design Development Improving the return rate of a smart pillbox in a circular economy 7574 5.3.2. Design insights 1. The design should primarily address the postal return scenario in the initial stages, as it's perceived to be easier for users to understand and more in line with their perception of product return. As the infrastructure for smart collection strategies develops and becomes more widespread, the design could then be adapted to accommodate these return methods. 2. The communication of return information needs to be simplified and naturally integrated into the user's interactions with the pillbox. This could include activities such as opening and closing the pillbox, removing pills, and resetting alarms. This simplification aims to make the return information less intrusive and more organically part of the user's experience. 3. The value proposition of returning the pillbox should be clearly communicated to users. This includes not only the practical aspects of the return process, but also the environmental and societal benefits. However, the focus should remain on the non-monetary value, as the monetary incentive may distort the user's decision-making process and make it more difficult to assess the ability aspect. 4. Constant reminders need to be integrated into the design to encourage the user to complete the return process and avoid forgetting. This should minimise the likelihood of the pillbox being left unused at home and encourage a seamless return once the user has decided to stop using it. Design Development Improving the return rate of a smart pillbox in a circular economy 7776 5.4. Design Concepts Four preliminary design concept were developed to explore the design that has the potential to improve the return. The design concept shown in Figure 14, derived from the idea of minimising the work involved in returning pills to the post office, incorporates a pre-paid envelope that is stored underneath the moveable transparent containers within the tray. When the small container is lifted to remove the pills, the user will find this envelope. Designed to resemble gift wrap, the envelope contains a prepaid stamp with a barcode that can be scanned by postal staff. On the back of the envelope are step-by-step return instructions and a catchy slogan: "Gift the Planet-Return for a Circular Tomorrow". This communication prepares the user or returner for the context of the return and provides clear guidance on the steps involved. The user simply places the pillbox in the envelope, seals it and takes it to any service point of the cooperating postal carrier. At the postal facility, the barcode on the envelope is scanned to register the shipment in the system. The prepaid nature of the envelope eliminates any return costs, further encouraging users to participate in this circular practice. 5.4.1. Concept A: Integrated return envelope Keywords: Return envelope; Return instruction manual. Developed from: 4. Pop-up card; 5. Movable container Figure 14 Prototype of concept A The concept shown in Figure 15 aims to increase the user's understanding of the context of the return and to simplify the return process through the use of a pre-paid return label. Interestingly, the design uses a small detachable lid on the back of the pillbox to pique the user's curiosity and encourage further exploration. This lid, which resembles a photo pendant, contains a folded manual with comprehensive step-by-step instructions on the return process. The manual clearly explains the reasons for returning the pillbox and how to do so, while reassuring the user of the privacy and security of their data. When the lid is removed, the user discovers the return label, which, when placed on the surface of the pillbox, serves as a constant reminder that the device should be returned at the end of its use. In addition to its functional role, the removable photo pendant adds a personal touch and serves as a souvenir for users, reminding them of their time with the pillbox. This design concept thus integrates informational and emotional elements that encourage users to return it. 5.4.2. Concept B: Photo charm and folded return manual Keywords: Postal label with barcode; Return instruction manual. Developed from: 1. Name card; 4. Pop-up card Figure 15 Prototype of concept B Design Development Improving the return rate of a smart pillbox in a circular economy 7978 This concept provides a simple solution by incorporating return instructions directly on the back of the pillbox, as illustrated in Figure 16. To trigger the return behaviour, its backend system sends a message to the registered user's mobile number when it detects inactivity for more than a month. This message includes return instructions and an image of a pre-paid return label. For returners whose phone number is not known to the system, they can simply scan the QR code on the back of the pillbox. This QR scan action triggers an automatic text message with a unique code to the system. As a result, the returner receives the return instructions and postal label, mirroring the process provided for the users. This approach simplifies the returns process and ensures that all relevant instructions and resources are readily available to both users and returners. 5.4.3. Concept C: Direct instruction and text message Keywords: Instruction printed on pillbox; Text messages. Developed from: 2. Flipped cover Figure 16 Prototype of concept C This concept is designed to allow users to proactively request information about the return process after they stop using the smart pillbox. As shown in Figure 17, a 'return mode' switch is built into the design which, when activated, disables alarms and notifications, and resets the pillbox. When the return mode is activated, users receive a message with return instructions and a return label to the phone number they originally registered with the system. If the message does not arrive, users can scan the QR code to access a dedicated website where they can provide a phone number or email address to receive the return label. This platform also provides additional information about the return process and helps users locate a nearby service point. By allowing users to initiate the return process at their own discretion, this approach enhances user engagement and increases the likelihood of product return. 5.4.4. Concept D: A switch for return mode Keywords: Button/switch for return mode; QR code for instruction; Text messages. Developed from: 3. NFC band Figure 17 Prototype of concept D Design Development Improving the return rate of a smart pillbox in a circular economy 8180 5.5. Concept Selection The subsequent design evaluation and selection session was strategically designed to test the viability of the proposed concepts. This session involved both the target user group (senior group) and the returner group (junior group) and provided an opportunity to assess the suitability and effectiveness of the designs in addressing the design challenges raised. The primary objective was to assess how these design concepts addressed the identified design challenges, thus facilitating the selection of the most promising concept and gathering critical feedback for future iterations. Through the analysis of the user feedback, this exercise aimed to identify the design elements that would effectively improve user ability in participating in the returns process and increase user engagement. Different groups of participants were involved in this session, allowing the researcher to identify how the design of the return experience met the needs and expectations of both users and returners. It also sheds light on how the designs could bridge the knowledge gap between these two groups. Detailed information on the research setup and participant demographics can be found in Chapter 2.2.9. "Concept selection". 5.5.1. Results The concept selection session required participants to rate the four design concepts by assigning scores corresponding to their level of agreement with a series of statements. Each statement corresponded to a specific value to be measured and related to a specific design aspect that addressed a previously identified HMW question from the design process. A comprehensive listing of these statements and their respective values is provided in Table 12. Aspect HMW Questions Values Evaluation Statements Returnabilityawareness How might we make users aware of the returnable property of the product? Knowing what to do I was attracted/led to learn about the return process and method. Confidence in system I understand that the return of the pillbox will have ethical and sustainable results. User trust How might we build user trust in the returns process? Feeling trust and privacy I believe that this process is reliable and trustworthy. Avoid negative feelings I was confused/upset/ sceptical when I learnt about the return and collection. Clear instruction How might we provide intuitive instruction and aids to facilitate the return behaviour? Understanding the instruction I feel confident to follow the return process outlined in this design Being reminded I am very likely to forget to return this pill box Convenience in daily life How might we make the return a convenient task that fits the users’ everyday planning? Making little effort I feel that returning this pillbox is cumbersome. Fitting everyday planning I do not have the time or energy to participate in the return process. Table 12 Tested statements and respective values, design aspects, and HMW questions. Design Development Improving the return rate of a smart pillbox in a circular economy 9594 Figure 22 Framework of return page. Design Development Improving the return rate of a smart pillbox in a circular economy 9796 5.6.3. Return Journey Proposal Figures 23 and 24 show the potential return journey of the proposed application example. These user experience journeys show the task or action to be performed by the user/returner, the response of the system and how they interact. Return Journey - User Figure 23 Customer Journey-User Design Development Improving the return rate of a smart pillbox in a circular economy 9998 Return Journey - Returner Figure 24 Customer Journey-Returner Design Development Improving the return rate of a smart pillbox in a circular economy 101100 5.6.4. Prototype A functional prototype (Figure 25) of this example of application was made to validate the effectiveness of the combination of design features. Basic features such as Bluetooth synchronisation, alarm notifications and LED indicators are operational. However, there are a few features of the redesigned model that have not yet been implemented in this prototype: the slide switch's ability to turn off the pillbox and the touch sensor's ability to trigger an app notification. These functions can be added by updating the board's firmware. Despite these limitations, these features can be easily demonstrated manually, making this prototype sufficiently robust for concept validation. Images of the prototype are shown in the figure below. Figure 25 Prototype of the final redesign Design Development Improving the return rate of a smart pillbox in a circular economy 103102 5.7. Design Guidelines Based on the extensive research, testing, and real-world application of the redesign, this project serves not only as an innovative solution for a product, but also as a case study. This chapter builds on the findings and insights from research on redesigning smart pillboxes. It serves as a guideline to provide actionable recommendations on promoting circularity in the design of similar healthcarerelated smart devices. The fundamental aim of these guidelines is to encourage designers and manufacturers to rethink their approach to the EoL phase of their devices, to facilitate their return and collection. The detailed guidelines are listed in Table 14. Emphasize the device's identity as a returnable healthcare product. Address potential 'returners' who might not have in-depth knowledge about the product to promote product circularity and EoL return success. Design for 'Returner' Identify pivotal moments for nudging users or returners about the return process. Intervening during these crucial times may be more effective. Examples from this project include when users first learn about the product, decide to stop using it, interact with it after discontinuation, and when returners first encounter the device. Key Moments of Nudging Integrate return and collection reminders seamlessly into the natural interaction process between the user and the device. This constant reinforcement ensures the return concept isn't easily forgotten or overlooked. Seamless Return Reminders Utilize nudging design elements that alter the user's perception of the device or its return process. Leverage the psychological impact and ambiguous categorization of borderline medical devices to foster lifecycle friendly EoL decisions. Change of Perception Keywords ExplanationCategories User Interaction Table 14 Comprehensive guidelines Ensure that from the onset, users are aware of the product's intended lifecycle, including any EoL services, refurbishment opportunities, or the potential for reuse. This can be facilitated through in-product notifications, packaging, or user manuals. Lifecycle Communication Clearly mark the device with identifiers that highlight its returnable nature. This aids users and returners in quickly recognizing its returnable trait, preventing inappropriate disposal. Prominent 'Return' Markings Refrain from solely using independent paper materials like flyers or envelopes as prompts. They have a high likelihood of being lost or discarded during user interaction, hindering returner's access to return information. Avoid Solely Paper-Based Cues Elevate the proportion of hardware elements related to returns and collections. A higher ratio might enhance user trust in product collection and returns and their assessment of the company's circular economy initiatives, motivating participation. Increase Return-Related Elements in Hardware Utilize the intelligence of the device to discern user activity. Based on this, employ SMS to send targeted reminders to users or returners at various stages, ensuring proper device use and prompt returns during inactivity. SMS is an effective communication mode accepted by users of such products. SMS Notifications Keywords ExplanationCategories Communication Trust & privacy Depending on the device's functionality and category, offer accessible, and visibly simple methods to erase data. This ensures user data security, increasing their trust and sense of security. Provide Data Erasure Methods Offer insights to users about the post-collection story of the device. Showcasing how the returned device is cleaned, processed, and remanufactured can foster trust and incentivize user participation. Transparency in Remanufacturing Journey Table 14 Comprehensive guidelines Design Development Improving the return rate of a smart pillbox in a circular economy 105104 Keywords ExplanationCategories Utilize integrated apps or web platforms to notify and guide users about the return process. This digital approach can also offer interactive FAQs, tutorials, and direct customer support channels. Digital Integration Initially prioritize accessible postal return processes, offering a familiar procedure for users and returners. As infrastructure improves, expand return channels by collaborating with local entities. Postal Returns as Primary Consider the use of deposits or other monetary incentives and ensure they are visibly marked on the product. Users view deposits as a powerful motivator for returns. If a deposit system is implemented, ensure users and returners are constantly reminded of its presence to avoid forgetfulness or unawareness. Monetary Incentives System Table 14 Comprehensive guidelines These guidelines aim to provide a comprehensive reference that identifies and addresses user needs and potential opportunities during the return and collection process. The intention is to support the design of devices that are inherently designed to be returned, ensuring ease of return, and understanding for both the end-user and the returner. This will increase the return rates of these devices, thereby promoting both environmental sustainability and resource efficiency in the healthcare sector. 5.8. Conclusion The results of this iterative design process include a deliberate selection of design features with the goal of improving the endof-life return of the smart pillbox. Furthermore, an exemplary application of these features was described, along with a comprehensive guideline destined for wider application. The next step in this process should be concept validation to evaluate how well it meets the design requirements and addresses any design difficulties. This will ensure that design elements not only fulfil the theoretical expectations but also align with practical requirements. 107 Chapter 6 Evaluation Concept Validation Impact on Material and Lifecycle Limitations This chapter evaluates the project and explores the impact and effectiveness of the proposed design features on the difficulty of EoL returns and the facilitation of return decisions in the context of circular economy and edge medical device design. It also critically reflects on the limitations encountered during the research and design process and provides an understanding of areas for future improvement. Evaluation Improving the return rate of a smart pillbox in a circular economy 109108 6.1. Concept Validation The concept validation was carried out to assess the interoperability and combined impact of various design features, specifically: the switch for state, the printed instruction, the deactivate/reset button and the web/appbased return instruction, as described in the previous chapter. The primary objective was to determine the collective effectiveness of these design elements in addressing the design challenges previously outlined. Feedback for this validation was gathered from a mixed group of five senior users, the target demographic for the smart pillbox, and five junior participants who could potentially act as returners. Data was collected through structured questionnaires and brief interviews to ensure a comprehensive understanding of user perspectives. Central to this validation was understanding changes in users' perceptions of the complexity of the return task and their confidence in completing it. Key desired outcomes of this validation included: 1. Quantify improvements in users' perceptions of difficulty and their selfassessed ability. 2. Measure the percentage increase in users' willingness to participate in the return process. 3. Evaluating how the newly integrated features improved the original design, focusing on four key aspects: Raising awareness of returnability, increasing user confidence, providing clear instructions and ensuring convenience in daily routines. A more detailed breakdown of the research design and methodology can be found in Chapter 2.2: Methods - Concept Validation. 6.1.1. Results In the questionnaire, participants assigned scores corresponding to their level of agreement with a series of statements. The aspects of the current pillbox and proposed design can be reflected from the statements shown in the table 15 and 16. Aspect HMW Questions Evaluation Statements Returnabilityawareness How might we make users aware of the returnable property of the product? Without asking for help, I understand that this pillbox should be collected. I consider the return of unused pillboxes to be a rule to be followed by default. I understand what this pillbox will be collected for. User trust How might we build user trust in the returns process? I believe that this pillbox will be collected correctly. I think this system is safe, reliable and trustworthy. It makes me feel good to be part of this return process. Clear instruction How might we provide intuitive instruction and aids to facilitate the return behaviour? I have received enough guidance to complete the return. I am confident that I will be able to complete the return. This pill box will ensure that I don't forget to return it. Convenience in daily life How might we make the return a convenient task that fits the users’ everyday planning? The process of returning the pillbox had few steps and was easy Returning the pillbox fit in with my lifestyle. Learning how to return the box was natural and intuitive. Aspect Evaluation Statements Perceived difficulty Overall, the return of the pillbox was easy. Self-assessed ability I now feel able to complete the return process on my own. Willingness I will be proactive in returning and collecting the pillbox. Table 15 Statements and their corresponding aspects Table 16 Statements related to the comprehensive evaluation of difficulty, ability and willingness. Evaluation Improving the return rate of a smart pillbox in a circular economy 111110 Overall, the combination of design features reached a good result in addressing the design challenges as expected. As illustrated in figure 26, it improved the current situation especially in the aspects of providing information for awareness and instruction. The detailed feedbacks for these four aspects are shown below. Figure 26 Performance in 4 aspects Returnability-awareness Feedback from participants on awareness was generally positive. Over half of the participants agreed that the redesigned pillbox with slogans and instructions increased their awareness of the 'return' channel. This was a significant change from the original pillbox design and prompted consideration of potential return options. In addition, the extensive information provided via the app/ web interface further clarified the details of the return process, including its underlying rationale. In particular, three participants highlighted that the pronounced colour disparity (green) resulting from the state switch was instrumental in drawing attention to the 'return' information. While the influence of specific colours on users' return perceptions was beyond the scope of this validation study, it warrants attention in future research efforts. User Trust In terms of fostering trust, the redesigned features produced the expected results. Overall, participants expressed a high level of trust in the return mechanism. A majority (seven participants) felt a sense of value in the return and collection by the manufacturer, as evidenced by the significant design real estate allocated to the return and collection process. This specialised hardware adaptation, perceived as an investment, reinforced the trust that the company's commitment to the collection of pillboxes was a long-term commitment. Consequently, this perception significantly boosted trust. Moreover, one participant expressed an interest in understanding the post-collection journey of the boxes. While this didn't diminish his trust quotient, a more in-depth exploration of the company's circular economy strategies could boost the overall trust metrics. The potential influence of this aspect on user participation requires further research. Clear Instructions Overall, the new design features provided participants with sufficient instructions to facilitate the return process. The front-facing return instructions were appreciated for their assistive and reminder functions. However, one participant commented that despite the clear instructions on the box, he resorted to scanning the QR code for the essential return label, suggesting a potential barrier to return. Such feedback is consistent with previous concept selection findings and highlights the need for ongoing experimentation to identify an optimal alternative to the QR code as the primary access point for the return label for the returners. Interestingly, after reading the sequential return instructions, several participants internalised them as a personal responsibility, evoking a sense of mission. This insight may inform strategies to increase user engagement in collection efforts. The effectiveness of such an approach and its underlying mechanisms will require more detailed design analysis. Convenience in daily life While participants praised the streamlined nature of the process, the design changes showed less improvement in the 'convenience' aspect compared to the other three aspects. This may be due to the inherent limitations of the underlying postal system, which blocks attempts to refine certain physical interactions. The increased convenience was largely a result of users and returners being more intuitive about the details required, a sentiment supported by the 'awareness' and 'instruction' feedback. In addition, observational data from prototype interactions revealed that some participants initially overlooked the slider's role in modulating the device's state, possibly due to reduced marker visibility. Their focus may have been monopolized by salient elements such as instructions or slogans. However, once the slider's function was recognised, a unanimous preference emerged to position the slider in the 'return' section during the interval preceding formal returns, as a reminder for return. Evaluation Improving the return rate of a smart pillbox in a circular economy 113112 Perceived difficulty and willingness According to the results of the questionnaire, shown in Figure 27, there was a notable improvement of 14.29% in participants' perceived ability - measured by their confidence in completing the return process - compared to the existing smart pillbox. When broken down, the junior group experienced an increase of 11.43%, while the senior group's confidence increased by 17.14%. Similarly, participants experienced a reduction in perceived difficulty, as evidenced by their assessment of the simplicity of the process, with an overall reduction of 15.71%. In particular, seniors experienced a more pronounced decrease of 22.86%, while juniors experienced a more modest decrease of 8.57%. Crucially, the overall propensity to participate in the return process increased by around 40%. Broken down further, juniors showed a significant increase of 48.57%, while seniors showed an increase of 31.43%. Figure 26 Performance in 4 aspects 6.1.2. Conclusion The concept validation has highlighted the potential of the modified design features to effectively address the challenges identified in the initial design process. Across both the senior and junior groups, there is clear evidence of improved awareness, confidence, instructional clarity and convenience of the smart pillbox return process. In particular, the senior group showed increased confidence and reduced perceived difficulty, suggesting the adaptability of the new design to meet the needs of older users. Meanwhile, the junior group's significant increase in willingness to participate, driven by an increase in trust, exemplifies the design's ability to effectively engage a younger demographic. Despite these advances, the validation also highlighted areas for further refinement. For example, the use of QR codes as a gateway to return labels and the design of on/off markers warrant deeper investigation and optimisation. In addition, certain aspects of convenience in the return process, influenced by external factors such as the postal system, pose inherent challenges. In summary, the revised concept represents a promising step forward in promoting a proactive return, with the lessons learned from validation paving the way for more nuanced iterations in the future. Importantly, the test results reveal potential avenues for future design exploration and research, setting the stage for ongoing innovation and refinement. 127 Appendices Appendix A Research Project Report Appendix B Graduation Project Brief Appendix C HREC Approval Letter Appendix D Consent form Template Appendix E Questionaires for Exploratory Test Appendix F Cocreation Notes Appendix G Questionaires for Concept Selection Appendix H Questionaires for Concept Validation