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Far from ‘boxed in’: The innovative design transforming at-home testing
Alexander Parker is head of wellness at packaging design and manufacturing company, Burgopak.
Burgopak is a world leader in design innovation, with a 25-year-history spanning entertainment, consumer tech and now health diagnostics, including an expanding range of at-home hormone and fertility testing kits.
We speak to Alexander to discover what goes into designing robust, functional but engaging packaging and the sometimes surprising considerations that can make or break a product.
Hi Alexander. Please tell us about your role at Burgopak.
My role is about driving our growth and direction in the healthcare and wellness space, which in practice means everything from packaging to client engagement, to partnerships, to developing the team.
I also sit on the company management committee and help manage our IP portfolio.
Before stepping into this role, I spent 20 years as a designer, 15 of them as head of design – so I bring a hands-on understanding of what it takes to deliver great packaging.
At-home test kits require the user to perform a medical procedure alone, without professional support.
How does that inform your design approach?
It’s a key pillar of a project, heavily influenced by the product and its intended use.
In the case of a test kit being used to collect a sample specimen and return it to a lab, there’s often plenty of opportunity for packaging to help or hinder the process and experience.
There are layers to effective packaging.
● Structure – Physical interventions through the packaging.
● Artwork – The visual identity, messaging and instructions across the pack and instructions for use.
● Signalling – Sometimes-undervalued but what signals are communicated through the packaging – how this makes the user feel about the product, the company behind it and the task at hand.
Careful design of the instructions for use is universally appreciated and often a regulatory requirement.
However, the pack structure and artwork should also work together to communicate a clear user journey.
This could include presenting components in the order they’re used, aligning the pack layout with the IFU steps (Prepare>Test>Return), making the IFU immediately visible as a hero component.
We can also introduce physical aids, like collection tube stands, to help during the sampling process.
The packaging is often used in the return of the sample to a lab so this needs to be considered and intuitively designed.
The structure, materials and artwork are all communicating something to the user.
You want to reassure the user by signalling care, efficacy, trust and in the case of a paid product, value.
In your mind, compare these two pack examples.
One a simple carton with a sea of components loosely filled and rattling around inside. Poor quality print and seemingly damaged in the post.
Contrast that with a suitably robust piece of packaging, with the components arranged and labelled into steps 1, 2, 3.
They might both work, but you can imagine the second building a reassured user experience.
How often do you encounter brands that haven’t thought about the emotional and potentially anxiety-inducing moment of opening a testing kit, and what’s the first thing you fix?
Thankfully it’s not too often, in our case at least.
I think we tend to attract customers who sense there’s more to packaging than just being a container or functionally driven.
The start of a project for us is building a brief with the customer and aligning on values for the packaging – what we want people to feel when opening or using it – as well as defining the technical requirements.
So, if there’s going to be an early fix it’ll probably be here, establishing the emotional intent.
How has the rise in social media ‘unboxing’ videos and product reviews changed what you do?
Is there a tension between designing for social media shareability and designing for the privacy women often want around health testing?
I don’t think there has to be a tension, provided everyone is clear on what the goals of the packaging are, and they are aligned with the product type and its use.
We can’t influence the results of a test or the positive or negative emotional significance it has in someone’s life.
What we can do is design packaging that offers the best possible user experience.
If there’s a shareable moment at the end, packaging might be a prop within a photo or video. But equally it might be a very private experience.
If it’s a test offering a diagnosis or insights into a health condition – you can conceive of a range of emotional outcomes. As you could imagine for certain fertility products too.
The design needs to acknowledge all these possibilities in its structural design, visual identity and the signals they communicate.
For women using a fertility or hormone test, perceived quality signals trust.
How do you stop sustainable choices from reading as cheap?
Do the essentials well, look for small interventions that add value and use attention to detail to signal that the care taken over the packaging, and sustainability, extends to the user.
Material choice is incredibly important.
In the case of paperboard quality can be a spectrum so it’s important to take the time to find and qualify the right one.
One that offers the necessary performance characteristics, is verifiably from responsibly managed forests such as through FSC/PEFC, and from a mill whose activities are aligned with your sustainability targets.
Take care over the design of each touch point and detail. A fitment that holds a device should neatly cradle it. A closure should be intuitive to open and work every time.
If the pack is meant to stand up, then the proportions should be optimised to facilitate that. It’s attention to the details that’s important.
Print quality will have a big impact on perception, not just the messaging or visual identity it renders. If the print quality is poor, then it devalues the product.
Doing it well doesn’t mean using material resources – it’s careful vendor selection and quality assurance.
For some responsible premiumisation you can introduce embossing or debossing details to the artwork, a tactile three-dimensional finish.
This details-led approach is valuable across all packaging but if sustainability is driving a reduction to the essentials, then there is a heightened importance to the execution of what is left.
As at-home health testing moves into NHS and public health contexts, what does good packaging look like when the brief is scale and cost rather than aspiration?
Scale and cost often feature very heavily in the success of projects outside of these settings, so there are parallels between the public and private, but with greater imperative to strip things back.
What is important to understand is success is not a piece of packaging in isolation. It’s efficiency, kitting, quality, distribution, tracking, data management across all activities and partners. Packaging is one part of the bigger picture.
Central to all of this is the need for it to reliably and consistently encourage the correct use of the kit through structure, artwork and instructions.
It is materially efficient and from a robust agile supply chain.
Assembly and kitting might be automated so it will be designed for those production lines or in conjunction with the equipment development.
It is compliant with all transport regulations and the most cost-efficient postal streams to the patient and from them back to the lab.
So, what does good packaging look like? It’s the design that efficiently offers the best patient user experience through a robust, reliable, scalable supply chain.
How do you make the business case for investing in packaging design before the product itself is ready to market?
There’s an opportunity cost.
Packaging has the potential to be a valuable asset when someone invests time and resources into coherent design and development. By starting too late or under resourcing the process you risk having packaging that’s a commercial pain point.
At the earliest opportunity, you at least want to be selecting your packaging partners and have a clear understanding of the development timeline and milestones – structural design, prototyping, stakeholder feedback, artwork/labelling development, regulatory milestones, transit testing, stability testing, wetproofing, manufacturing, delivery.
You must complete these steps before your product can go to market.
What’s the cost to you of delaying launch because you didn’t get packaging underway sooner?
You need to spend time creating packaging that elevates your brand and is a marketing asset that works across ecommerce, retail, advertising, social media.
Engage with the other supply chain stakeholders.
One example would be involving kitting partners in the process to validate and input on packaging improvements. If it’s expensive to kit, your cost of goods go up and if it’s slow to kit you might not have a scalable solution.
You may also find packaging insights influence product decisions.
If you are defining components for a test kit, factor in that larger devices might in turn increase pack size and eventually incur higher shipping costs.
You might work with a device manufacturer on how a USB cable is wound so the packaging volume can be decreased – another potential packaging and shipping cost reduction.
Transit testing and design improvements ensure that products arrive in acceptable condition – reducing costs associated with replacements, damaged reputation and potentially the loss of repeat purchases.
Packaging done well is that opportunity realised – it’s value demonstrated across sales, marketing and operations.
For a founding team approaching a packaging partner for the first time, what does a genuinely useful brief contain, what do most brands leave out, and how much does coming in underprepared add to the timeline and cost?
At Burgopak we build a brief together with the customer and that usually happens in a few stages.
The initial conversation is a chance to learn more about each other, make sure we’re a good fit for one another and the project.
We like to learn more about you, your product, how it’s used and some headline information around timelines, volumes, budget, your packaging ambitions and likes/dislikes.
We explain what we do and how we typically work. This really is the kick-off point – the goal at the end of this stage is being excited to be working together on a project that looks technically and commercially feasible.
In the next stage we build-out a brief capturing the technical and brand-led requirements of the packaging.
It will cover product details, brand & experience, sales & delivery channels, fulfilment and distribution, budget and timelines, compliance and regulations.
The exact questions will vary by product and project, but they span those areas.
From this we can build the project plan – and this might involve working towards answers that aren’t yet defined.
It seems obvious, but knowing exactly what needs to be packaged is fundamental – the product, peripherals – and this can be one of the common missing puzzle pieces.
You can design a container to hold ‘something’.
But when you know exactly what the product is – its size, shape, weight, how it’s used – you can design a piece of packaging that is maximally efficient and effective in elevating the total product experience.
The risk to a successful project is not so much under preparedness at the start – we’re here to help build the brief and a realistic project plan – it’s a loss of momentum through the process.
The packager and the client must work together.
We can be very efficient and agile in doing the work but there’s also the responsibility from the client to keep momentum through rounds of feedback, coordinating product samples or technical drawings and so on.
If there’s a finite timeline and repeated delays within it there can come a crunch point – when delivery dates are pushed out or potentially avoidable compromises made.
Come prepared to collaborate on the brief – but know that the founding teams who get the best outcomes are the ones who stay engaged and keep momentum through the whole process, not just the kick-off.
Learn more about Burgopak at burgopak.com
Women using menopausal hormone therapy had a lower dementia risk, with oestrogen-only users showing fewer Alzheimer’s-related brain changes in a recent study.
Researchers stressed that the findings do not show that hormone therapy prevents dementia, but found women using oestrogen-only treatment had fewer biological signs linked to Alzheimer’s disease.
The observational study also found that women using this form of hormone therapy were less likely to receive a clinical dementia diagnosis.
The study combined clinical data with biomarkers and evidence from brain tissue collected after death to build a more detailed picture of the relationship between hormone therapy and Alzheimer’s-related changes.
The findings contrast with several previous studies reporting that menopausal hormone therapy increases dementia risk.
Dr Hadi Hosseini, associate professor of psychiatry and behavioural sciences at Stanford University in the US and senior author, said: “Our study is unique in that we looked at all the standards of Alzheimer’s diagnosis, including the gold-standard outcome: Alzheimer’s-associated hallmarks in autopsied brains.”
Hosseini said many conditions can affect memory and that clinical diagnoses are not always accurate. Examining brain tissue allows researchers to look directly for the defining biological features associated with Alzheimer’s disease.
Researchers examined medical records from 21,462 women taking part in two large US studies.
They looked only at women who used oestrogen-only therapy because previous studies indicated that treatment combining oestrogen and progestin may increase dementia risk.
This group was compared with women who reported no use of menopausal hormone therapy.
The records included data from 258 brain autopsies of women who had reported using oestrogen-only menopausal hormone therapy and 2,701 autopsies from women who had not used hormone therapy.
After adjusting for factors including age, women who took hormone therapy had a 35 per cent lower chance of showing biological signs of Alzheimer’s disease than those who did not use hormone therapy.
Hormone therapy use was also associated with a 39 per cent lower risk of receiving a clinical dementia diagnosis and a reduced risk of memory problems or declining functional abilities.
Dr Tom Blackmore, research programmes manager at Alzheimer’s Research UK, said: “Dementia has been the leading cause of death for women in the UK for over a decade, yet we still don’t fully understand why women are more likely to be affected by the condition than men.
“Understanding how hormones, menopause and ageing influence brain health is an important area of dementia research.
“While these findings are interesting, this study can only show an association and cannot tell us whether hormone therapy itself reduced dementia risk.
“Many factors influence a person’s likelihood of developing dementia, and women who received hormone therapy may differ from those who did not in ways that also affect their long-term brain health.”
In current standard practice, oestrogen-only therapy is prescribed to people who have undergone a hysterectomy because of the increased risk of endometrial cancer.
Blackmore also said the study focused exclusively on women taking oestrogen-only hormone therapy, which “differs substantially from how hormone replacement therapy is typically used today.”
Although early studies suggested menopausal hormone therapy might help protect menopausal women from dementia, later research produced inconclusive results.
A large analysis published in 2003 suggested the opposite, finding that oestrogen-plus-progestin formulations appeared to increase dementia risk, particularly when started at an older age.
Hosseini said: “There have been a lot of conflicting findings about MHT’s [menopausal hormone therapy’s] effects on Alzheimer’s disease outcomes.”
He added: “Different studies may have involved different age ranges of initiating MHT.”
Hosseini said studies may also have examined different clinical outcomes and biomarkers, combined different hormone therapy formulations or looked at different routes of administration and treatment durations.
Blackmore added that the findings “are not a reason for women to start or stop hormone replacement therapy with the aim of reducing dementia risk.”
He added: “Instead, the study provides valuable clues about the biology underlying dementia and highlights the need for more research into women’s brain health.
“Larger and more diverse studies will be needed to determine whether hormone-based treatments could play any role in reducing dementia risk.”
According to Alzheimer’s Research UK, an estimated 982,000 people are living with dementia in the UK, with around 65 per cent of those affected being women.
Health visitor support may help women who quit smoking during pregnancy remain smoke-free after giving birth, research suggests.
The BabyBreathe programme was designed to help women who stopped smoking before or during pregnancy avoid returning to smoking after childbirth.
The programme was funded by the National Institute for Health and Care Research and tested by a team led by the University of East Anglia.
Professor Michael Ussher of the University of Stirling’s Institute for Social Marketing and Health was a senior investigator on the study and led recruitment at two trial sites.
Ussher said: “This study is the first to show that an intervention focussing on support from a health visitor may help women avoid returning to smoking.
“These findings are important as many women stop smoking in pregnancy but then return to smoking soon after their baby is born.”
BabyBreathe provides one-to-one support from trained health visitors alongside digital tools, text message support, a dedicated website and app and a relapse-prevention kit sent to families after birth.
Women who received the intervention as intended, with support from trained health visitors, were significantly more likely to remain smoke-free 12 months after giving birth than those without health visitor support.
A total of 886 women from England and Scotland who had successfully stopped smoking before or during pregnancy took part in the large-scale randomised controlled trial.
Participants were randomly assigned to receive either BabyBreathe or usual care, which offered no advice or support aimed at preventing smoking relapse.
BabyBreathe was not delivered as intended to around one in five participants because of health visitor workforce pressures, missed appointments or administrative problems.
Health visitors provided tailored one-to-one advice and support to women in the intervention group towards the end of pregnancy and immediately after their baby was born.
The support included advice on alternatives women could try if they experienced urges to smoke again, as well as advice for partners and family members and access to digital resources including the BabyBreathe app and website.
A relapse-prevention kit was also posted to women immediately after their baby was born.
Support continued for up to 12 months after childbirth during routine health visitor appointments.
The intervention followed more than a decade of research and development involving women, families, health professionals and researchers who worked together to design, develop and test the support package.
Among participants who received the intervention as intended, 57.6 per cent remained smoke-free after 12 months, compared with 49.9 per cent of those receiving usual care.
Researchers said the findings suggest health visiting services could play a significant role in providing consistent relapse-prevention support and helping more mothers remain smoke-free after giving birth.
Lead researcher Professor Caitlin Notley, professor of addiction sciences at UEA’s Norwich Medical School, said: “Women of childbearing age who quit and stay non-smoking can reduce their risks of developing a smoking-related disease to almost the same level of risk as non-smokers.
“There are also great benefits for babies and children brought up by parents who do not smoke in avoiding exposure to second-hand smoke, and in helping to prevent the next generation from taking up smoking.
“Until now, health visitors had no training on smoking relapse prevention.
“This meant that when women had made the extremely important and difficult health behaviour change of quitting smoking during pregnancy, no one picked up on this and gave them positive praise and support.
“This new approach extends the intensive support for initially quitting smoking that pregnant women are offered, going one step further to help women to stay smokefree in the long term.”
Researchers noted several limitations that affected the primary analysis, including incomplete delivery of BabyBreathe and low engagement with some parts of the programme.
The participant group was also more highly educated and less socioeconomically deprived than the wider population, which may have affected the programme’s overall effectiveness and limit how broadly the findings can be applied.
The Institute of Health Visiting worked with UEA on the BabyBreathe study.
Vicky Gilroy, director of innovation and research at the Institute of Health Visiting, said: “Health visitors and their teams are uniquely placed to support women in preventing smoking relapse as part of their universal offer.
“It has been a privilege to contribute to the BabyBreathe study and help develop the evidence of the importance of their role. The findings reinforce the need for all health visitors to receive training in this important area.”
Women with endometriosis say menstrual leave and flexible working would help most, as research estimates yearly income losses of €1,757 (£1,502).
Pain and fatigue were linked to more frequent work absences and reduced job performance.
The first large-scale study of its kind in Central and Eastern Europe estimated that women with the condition lose an average of €1,757 in income each year, roughly equal to one month’s average salary in Hungary.
The estimate covers income lost through work absences and does not include reduced productivity while at work or healthcare costs.
Researchers at Semmelweis University analysed data from 566 women with endometriosis and 447 women without the condition.
Using internationally validated questionnaires, they assessed work productivity, absenteeism and work ability.
Women with endometriosis lost an average of 12.7 working hours over four weeks because of health-related problems, compared with 5.7 hours among women in the control group.
Based on the hours missed, researchers estimated an average annual income loss of €1,757 for each affected woman.
Dr Dóra Balogh, assistant professor in the Department of Obstetrics and Gynaecology at Semmelweis University and senior author, said: “The impact of endometriosis is not only a health issue but also a major social and economic one.
“The condition affects women during one of the most active stages of their lives, meaning it can influence employment, career development, and long-term financial security.”
Endometriosis affects about 10 per cent of women of reproductive age worldwide.
It is a chronic gynaecological condition in which tissue similar to the lining of the womb grows outside the womb, causing chronic pelvic pain, painful periods, fatigue and, in some cases, infertility.
Symptoms often persist for many years before the condition is diagnosed.
The study found that 42 per cent of women with endometriosis had poor work ability, compared with 17.9 per cent of women in the control group.
Poor work ability means a person’s health makes it harder to perform their job and increases the risk of prolonged work disability or leaving the workforce.
Dr Dominika Miklós, resident physician in the Department of Obstetrics and Gynaecology at Semmelweis University and first author, said: “The most surprising finding was that nearly half of the women with endometriosis fell into this category.
“Without appropriate support, the condition may not only make day-to-day work more difficult but also threaten women’s ability to remain in the workforce over the long term.”
Researchers also found that many workplaces were not adequately prepared to support employees with endometriosis.
Some 54 per cent of respondents said their employer had little or no knowledge of the condition, while only 17 per cent believed their workplace was sufficiently informed about it.
Participants said they would most value menstrual leave, flexible working hours, remote or hybrid working and greater understanding and support from employers.
Some European countries, including Spain and Portugal, already allow menstrual leave in certain circumstances.
The research formed part of the international FEMaLe, or Finding Endometriosis with Machine Learning, programme, launched in 2020.
At Semmelweis University, the project is led by Dr Attila Bokor, associate professor in the Department of Obstetrics and Gynaecology.
The programme aims to improve understanding of endometriosis, promote earlier diagnosis and investigate its health, social and economic impact.
Researchers said it was the first comprehensive study in Central and Eastern Europe to examine work productivity, work ability and workplace support at the same time.
The findings were consistent with studies from Western Europe and Australia, suggesting the effect of endometriosis on working life is similar across regions.
Researchers concluded that flexible working arrangements and better-informed employers could help women with endometriosis remain in the workforce.
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