Insight
Bridging the gap: How can design research drive better healthcare outcomes for women?
By Hollie Johnston, Principal – Human Factors & Research at PDD, a global product and experience consultancy
It can no longer be argued that there is a data gap in women’s healthcare – with most available data historically biased towards men.
The underrepresentation of women in clinical research, often due to complexities of hormonal cycles has led to a lack of knowledge about drug impact on women.
Minimal research into support solutions for those suffering from endometriosis — which affects roughly 10 per cent (190 million) of reproductive-age women and girls globally — or the lack of consideration for physiological differences in load-bearing that lead to higher failure rates of certain hip implants in women than men, are just a few examples of how healthcare systems, shaped by incomplete data, have failed to address women’s specific needs, with consistent negative impacts on healthcare outcomes.
This data gap has huge implications for developing healthcare products, systems, and services.
It reinforces everyday experiences of bias and leads to unconscious bias when relying on Big Data. As AI technologies that emulate human intelligence and problem-solving capabilities advance, the risk of perpetuating inequality through incomplete and inaccurate datasets grows.
Designing better for women
As Caroline Criado Perez beautifully puts it in her book Invisible Women, “When designing, we need a woman in the room”.
From a design research perspective, this means considering the abilities, actions, and opinions of the intended user profile throughout the development process.
Even with the best of intentions, we cannot live another person’s experiences nor physically put ourselves in their shoes. If we tried, our conclusions would naturally be based on our experiences and understanding (inherent experience bias).
Including those with lived experience is a priority when planning research, not least when it comes to designing for women.
Consider a chronic condition such as endometriosis, which has a significant impact on the lives of sufferers.
Symptoms can vary from painful menstrual cramps and heavy menstrual bleeding, through to fatigue, and inability to get pregnant.
Symptoms can vary in type and severity over time – both during a monthly cycle, and over life stages.
Only by immersing ourselves in the lives and experiences of these women over an extended period can researchers and designers hope to understand the complexity of their needs, and therefore develop innovative and practical solutions that truly address them.
The woman in the room: Participant identification
As practitioners, delivering inclusive, user-driven solutions is at the heart of what we do.
A key component of development is identifying the correct stakeholders, identifying their needs and validating potential solutions with them.
This is where it becomes tricky.
On paper, proportional representation (where the proportion of participants recruited reflects the current real-world status) might seem like a valid method when recruiting.
In reality, in areas currently male-dominated, such as when researching ergonomics for cardiac surgeons, the needs and requirements of a much smaller female cohort would be significantly diluted, with potentially negative consequences in terms of device, system and service usability for women.
Therefore, participants should be selected on a case-by-case basis, using proportional representation as a starting point rather than a standard.
Building the stage: Study Setup
There are many ways to conduct design research and the method chosen should be relevant to the investigation topic. For example, evaluating a surgical tool might be best done in a surgical setting (or simulation lab).
Similarly, the setup of the evaluation should consider who is being evaluated.
Alzheimer’s, for example, is a disease that can be exacerbated by stress or change – such as the introduction of new people, activities, or equipment, all factors which are relevant to a research study.
When it comes to gender and sex, cultural and social factors might also be at play.
It may be inappropriate in some cultures, for example, for a woman to attend a solo face-to-face session or to speak to strangers about intimate health matters.
Study methodology is, therefore, critical to success.
When designing study methodology, it is important to consider not only technical objectives but also user profiles to ensure all demographics are adequately represented and evaluation methods do not negatively impact participation or study results.
Questioning your Insights: Translation & Analysis
Gathering the data is only one part of the puzzle; just as important is how we translate it and incorporate it into the development cycle to create actionable insights and form parameters for idea generation and selection.
At this stage it is all-too easy to fall back on assumptions and internal ‘knowledge’.
Instead, we should assess all ideas against the findings of our research to ensure they are grounded in actual user needs.
We must interrogate those ideas to understand what need they are meeting and why they are valuable.
We should also conduct an analysis to understand whether there are differences – or alignments – between cohorts and sub-cohorts.
Even within women’s health there may not be a ‘one size fits all’ solution. Take pregnancy tests, for example.
It can be safely assumed that taking a pregnancy test is an emotive time for most women; the result received, however, can be very polarising dependent on whether the user is actively trying to conceive, or not.
How do we ensure women are supported during this process – before, during and after test taking – when the response to the result can be so different?
The role of design research in shaping a more equitable healthcare future
The data gap in women’s healthcare is real. Not only is our physiology different, but so are our behaviours, attitudes, motivations, and cognition.
Passively relying on existing data or engaging the wrong stakeholders perpetuates the problem and misses opportunities for innovation.
In recent years, the rise of Femtech has opened the possibility to eventually close the data gap with wearable devices and companion apps to address the unmet health needs of women granting passive and active data collection for female-specific conditions (e.g. menopause, fertility, etc.).
But robust processes during product and service design, development, and evaluation remain crucial to ensure women’s distinct requirements are met.
Beyond product development, there is also scope to use design research and, more broadly, Human-Centred Design principles to drive change on a larger scale, influencing education, awareness, and policy.
A focus on organisational ergonomics, for example, applying HFE tools to organisational behaviour, can ensure that women’s needs are considered from the outset.
Crucially, addressing the data gap in women’s healthcare can set the scene to tackle further inequalities across genders, socio-economic groups and cultures.
Only by being aware of data limitations and actively collecting data to counteract them can we ensure we are designing for the right people in the right way and achieve healthcare equity for all.
An early PET scan after one cycle of chemotherapy may help predict how aggressive breast cancer responds to treatment, a study suggests.
Research led by The Institute of Cancer Research, London and King’s College London suggests that an early scan taken after one cycle of chemotherapy could help predict how well a patient’s cancer will respond to treatment.
The study focused on patients with triple-negative breast cancer (TNBC), an aggressive form of the disease in which cancer cells lack receptors for the hormones oestrogen and progesterone, as well as the HER2 protein.
Patients with TNBC are usually treated with chemotherapy prior to surgery. While many respond well, residual disease at surgery, typically around six months later, is associated with a significantly poorer prognosis. Identifying people sooner who are unlikely to respond remains a major clinical challenge.
The research explored whether using PET imaging shortly after treatment begins, rather than relying only on MRI scans later in the treatment process, could provide earlier insight into how a patient’s cancer is responding. Twenty-two patients were recruited, with fourteen undergoing FDG-PET scans before treatment and after the first cycle of chemotherapy.
The findings, published in Clinical Cancer Research, showed that changes seen on PET scans after just one cycle of chemotherapy were strongly associated with subsequent response, including whether there was no detectable cancer, known as a complete response, by the end of treatment. Importantly, early PET response showed stronger associations with treatment outcomes than standard mid-treatment MRI scans in this study.
Being able to identify patients who are not responding well at an early stage could allow clinicians to adjust treatment sooner or consider alternative approaches. These findings may also support future strategies to better tailor treatment intensity to individual patients.
The study also compared two types of PET tracers, FDG and FLT, to determine which was most suitable. While both met the study’s technical criteria, FDG-PET was selected for further evaluation due to its better image quality, greater consistency and wider use in clinical practice.
The research also explored how imaging changes after just one cycle of chemotherapy relate to the body’s immune response to treatment. Biopsies taken before and after the first cycle of chemotherapy showed that an increase in immune cells within the tumour was strongly associated with both early PET changes and improved treatment outcomes.
The researchers emphasise that these findings now need to be validated in larger studies. Future work will aim to confirm these results in broader patient groups and explore more accessible imaging approaches, such as ultrasound, alongside PET and MRI.
Sheeba Irshad, professor of cancer immunology at King’s College London and lead of the Breast Cancer Now KCL Research Unit, said:
“In patients who had PET scans both before treatment and after the first cycle, we found that this early scan could predict whether they were likely to achieve a complete response by the end of treatment. These findings highlight the potential of early imaging to guide treatment decisions, and now need to be validated in larger, modern clinical trials.”
Andrew Tutt, professor of breast oncology at The Institute of Cancer Research, London, said:
“Research that helps us determine early who is already benefitting from standard neoadjuvant chemotherapy and who might benefit from clinical trials to find better treatments is vital. This study shows that FDG-PET may have great value in this regard. We hope to be able to design studies that further investigate and validate these findings.”
The study was supported by funding from King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, Breast Cancer Now, Cancer Research UK, and Guy’s and St Thomas’ Charity.
Ki-67, a protein used to measure tumour growth, may also help prevent chromosome errors that drive cancer, a study suggests.
The findings could change how scientists view Ki-67, a marker commonly used in breast cancer and other tumours to assess how quickly cancer cells are growing.
Researchers found the protein may help preserve genome stability by maintaining the structural integrity of centromeres, key parts of chromosomes that help ensure DNA is shared correctly during cell division.
The research was led by professor Paola Vagnarelli at Brunel University of London in collaboration with scientists at the University of Edinburgh and the Technical University of Berlin.
Professor Vagnarelli said: “Doctors already measure Ki-67 to see how aggressive a cancer might be. But our results suggest it is actually helping maintain genome stability.
“That means it may be more than a marker. It could potentially also be a therapeutic target.”
The study examined three proteins that attach to chromosomes during cell division and help rebuild the molecular system that tells each new cell what kind of cell it is.
Every human cell carries identical DNA. What makes a liver cell different from a brain cell is which genes are switched on and which are kept inactive.
When a cell divides, that entire system of switches must be rebuilt. The three proteins involved in this process were Ki-67, Repo-Man and PNUTS.
Vagnarelli’s team developed a method that individually removes each protein from a living cell at the precise point of division. Older techniques could not isolate that moment cleanly.
They found that cells rely on all three proteins to reset themselves after division, but each failed in a different way when removed.
Without PNUTS, gene activity spiralled out of control and thousands of genes switched on at once.
Without Repo-Man, cells escaped safety checkpoints that usually stop damaged or abnormal cells from continuing to divide.
“What we didn’t expect was how clean the separation was,” said Vagnarelli.
Each protein fails in its own specific way. There is no redundancy, no safety net. Which means there are three separate points at which this process can go wrong.
“When the system breaks down, cells can emerge with the wrong number of chromosomes. That condition, called aneuploidy, is seen in disorders such as Down syndrome and in many cancers.
“We also found that these chromosome errors can trigger inflammatory signals inside the cell.”
Aneuploidy means a cell has too many or too few chromosomes, which can disrupt normal growth and function.
Inflammatory signals are chemical messages that can make a cell behave as if it is responding to injury or infection.
“These cells behave almost as if they are under attack,” said Vagnarelli.
“The immune response switches on because the genome is unstable.
“That link between chromosome imbalance and inflammation could help explain patterns we see in several diseases.”
The researchers said the findings may help cancer scientists better understand how chromosome instability, loss of gene regulation and cells dividing before they are ready contribute to tumour growth.
They said understanding the normal machinery that prevents these errors may help researchers find ways to push cancer cells into making mistakes they cannot survive.
“We now have a clearer map of the machinery that resets the cell after division,” said Vagnarelli.
“That knowledge gives us a starting point for thinking about new therapeutic approaches.”
After more than a decade of campaigning, doctors around the world have agreed to rename polycystic ovary syndrome (PCOS).
It is hoped the new name, polyendocrine metabolic ovarian syndrome, or PMOS, will help end the misconception that the condition is all about cysts, which campaigners say has contributed to missed diagnoses and inadequate treatment.
The condition affects one in eight women, or 3.1m women and girls in the UK, and is linked to hormone fluctuations that can affect weight, mental health, skin and the reproductive system.
The renaming was spearheaded by UK patient charity Verity alongside Professor Helena Teede, director of Melbourne’s Monash Centre for Health Research and Implementation.
It followed 14 years of consultation with clinicians and patients around the world.
The new name was published in a consensus statement on May 12 and announced at the European Congress of Endocrinology in Prague.
The paper states that PCOS should now be referred to as PMOS.
“This is a landmark moment that will lead to desperately-needed worldwide advancements in clinical practice and research,” said Professor Teede.
“It was heart-breaking to see the delayed diagnosis, limited awareness and inadequate care afforded those affected by this neglected condition.”
When doctors first named PCOS in 1935, they thought it was mainly caused by physical changes to the ovaries.
Decades of research have since changed that understanding, with clinicians now agreeing the condition is far more complex.
“What we now know is that there is actually no increase in abnormal cysts on the ovary and the diverse features of the condition were often unappreciated,” Professor Teede added.
“A name change was the next critical step towards recognition and improvement in the long term impacts of this condition.”
The exact cause of the condition is still unknown, though it is thought to be linked to abnormal hormone levels and is associated with insulin resistance and raised levels of testosterone and luteinising hormone.
Insulin resistance means the body does not respond properly to insulin, the hormone that helps control blood sugar. Luteinising hormone helps regulate ovulation.
Common symptoms listed by the NHS include irregular periods or no periods at all, difficulty getting pregnant, excessive hair growth, weight gain, thinning hair, oily skin and acne.
Campaigners have acknowledged that the name change could cause temporary confusion.
“Despite decades of tireless advocacy to improve awareness, we recognised that the risk of change would be worth the reward,” said Rachel Morman, chairwoman of Verity.
“This shift will reframe the conversation and demand that it is taken as seriously as the long-term, complex health condition it is.”
It is also unclear if, or when, the NHS will change the language it uses.
An NHS England spokesperson said: “We routinely review and update content on the NHS website to ensure it reflects the latest clinical advice and will carefully consider these recommendations.
“The NHS will also continue our work to improve women’s healthcare, including for this important group, which involves giving women more choice over their care, bringing down waiting times, and delivering more care in communities.”
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