Our brief: Design a digital service with a focus on ‘Women and heart attacks’
The Challenge
A heart attack has historically been perceived as a ‘male disease’, and has been understudied, under-diagnosed, and under-treated in women, leading to both the affected women and their male doctors mis-diagnosing a heart attack as symptoms of stress, anxiety or menopause related conditions.
The Approach
Our approach was to apply and practise our service design methodology, starting with research, discovery and user interviews, to explore the problem space and turn our assumptions into hypotheses, to test with prototypes and build an effective MVP by mitigating any evident risk through design iterations.
The Outcome
A toolkit for women in communities of all sizes i.e. cities, towns and villages. Empowering all women to start their own Heart Hub community via a digital platform. Inviting individual users to sign-up to join a Heart Hub community. For all members to explore educational resources and actively participate in their Heart Hub community.
The Impact
A service that has been positively rated in our final round of user testing as a desirable, useful and usable service. As a group of service designers, we are deciding on our next steps to roll-out a series of pilot programs that can be tested, monitored and optimised.
The brief
Professor Birgit Mager (President of the Service Design Network), introduced our team to the topic with a 90’s UK TV campaign from the British Heart Foundation, designed to educate the nation on what to do when someone is having a heart attack. The video shows a man performing CPR on another man.
- Due to the fact that there is no female representation, the advert led to a more widespread perception that heart-attacks are a “male problem”
- Recommended emergency CPR has been simplified since the campaign to exclude mouth-to-mouth instructions
Our task: Perform research into this topic to highlight key issues related to women and heart attacks. Develop a service that helps and supports one chosen area that our team discovers through our research.
Our team
Goals
Our team goals:
- Explore the gender inequality in this topic
- Understand any root causes of gender misrepresentation
- Ideate on design solutions that could dislodge false mental models
- Build a scaleable service for women by applying our women-centred design methodology
- Conduct research, engage with users through interviews and workshops to build a clear picture of problems, user needs and challenges
- Run a pilot program, test and improve our designed service based on our findings
Research
A snapshot of some of our preliminary research findings.
Gender inequality.
Some staggering facts that we discussed as a group.
- Women are 50% more likely than men to get the wrong diagnosis after a heart attack
- Some women have had to wait over 12 hours before receiving a correct heart attack diagnosis
- If a heart attack patient is a woman and her emergency physician is a man, her risk of death will rise by about 12 percent
Other important stories that we heard:
- The average age for a man to have a heart attack is 65, where for a woman it’s 71
- Women have a higher pain threshold than men
- Evidence that male doctors harbour ingrained prejudices against women
- In preclinical studies, female animals make up less than half of tested subjects
- In medical research, women are under-represented
- TV, film and the media have a huge role in portraying that someone suffering from a heart attack would be a male character. We could not think of any female character having a heart attack in a TV show or movie
Stakeholder map
Through a workshop we identified our target audience and stakeholder group in order to learn key information from them and strengthen our design decisions.
User interviews
In order to understand this difficult topic from a number of angles, we interviewed a range of people including women who had suffered from a heart attack, medical professionals and supporting family members.
Insight Clustering
- There are so many other campaigns for breast cancer, but not for heart health, even though women are twice as likely to die from heart disease than breast cancer
- It’s imperative to get the right treatment for a heart attack within the first hour, making an accurate diagnosis imperative
- The menopause is a complicated and sensitive topic that is not understood by most male physicians and can be a factor in mis-diagnosis
- Making small and positive life-choices / life-changes is hard, in particular the older you get, but the best thing you can do to improve your heart health
- Living a healthy lifestyle can help reduce the risk of heart disease. Try these heart-healthy strategies:
- Quit smoking
- Eat a healthy diet
- Exercise and maintain a healthy weight
- Manage stress
- Avoid or limit alcohol
Problem statement
Problem statement: Professional medical services have always included male physicians who are liable to give incorrect advice to women. Women need a women-centered solution as a way of reaching out, to share and learn stories about each of their lives, their health and their individual symptoms.
User persona
We summarised all of our research into a user persona.
Ideation workshop
We designed an hour-long workshop and invited a group of women of varying ages, cultures and backgrounds. Some of the women had health issues and were concerned for their health. Others had been affected by this topic with an ill family member.
General challenge of the workshop: To design interventions that will reduce coronary heart disease deaths in woman from prevention, late/ missed diagnosis, and inadequate medical treatment.
Section one: We introduced our topic with a summary of our research.
Section 02: Sailboat exercise.
Specific question for this exercise: How might we make it easier for women entering menopause to be aware on the risks of heart disease?
After ideating, we asked participants to read all the comments and dot-vote on those which they felt were the most important to explore and discuss further.
Section 03: Lotus flower ideation exercise.
Key quotes
“Being part of a community is so important to me.”
Mentioned by multiple participants
We conducted some additional research to understand some of the other local communities that our workshop participants spoke about. Our team saw how the participants spoke highly of these communities, initially for the social contact opportunities that they created, but many other unexpected benefits that grew over time.
“Hearing other women’s voices like mine would encourage me to listen more and make the right choices.”
Workshop participant #1
Listening to other women, being around other women, learning from other women, sharing stories with other women were all contributing factors that were empowering other women to strengthen their understanding of their needs. This was of particular interest knowing the impact that simple (yet difficult to change) life choicees can help improve heart health and reduce heart disease.
“Some menopause symptoms could seem the same as a heart attack and this needs to be understood more.”
Workshop participant #2
We discovered detailed information about menopausal symptoms being similar to the symptoms of a heart attack in our research. However hearing this comment and an agreement from other women in the workshop, we identified a need for this important knowledge to be communicated to women from other women (and remove men completely from any proposed solution) in order to raise empowerment, confidence and awareness in a critical moment when being diagnosed.
Hypothesis statement
Hypothesis statement: We believe that by creating a scalable toolkit for women to build communities for other women, for women to educate other women, formally and informally, that we will empower all women involved to make positive health choices in life that will contribute to the reduction of heart disease and heart attacks.
Measurable metrics: We will know when we have achieved our goal when we reach our three SMART goals:
- Through multiple rounds of design iteration, to improve the desirability and usefulness scores from potential users. This includes a survey of 100+ participants to score on a scale of 1-10 a minimum average score of 7 or above
- To empower women to share stories and invoke at least one small positive lifestyle change in each participant. To be captured in a gamification feature within our proposed responsive web app
- To roll out the program and get at least 6 groups started within the first 6 months
Prototype V1
Our first tested prototype was a desktop version of a proposed website portal designed to educate, connect women and act as a toolkit to build communities.
Our V1 prototype – desktop website landing page.
User testing
We conducted user testing with 5 women aged 24 to 71. We asked some general questions and then followed with these questions in order to understand who we could improve our initial idea.
- Can you tell me what the site is for?
- How do you think this site could help someone?
- Can you tell me why you’d visit this site?
- Who you think this site is aimed at?
- Tell me what information you find useful on this site?
- Tell me anything else you’d expect to find on this site?
- Is there anything that you’ve seen on a similar site / with a similar service that you think is missing?
- Do you have any last thoughts on the topic in the site?
- After seeing our page, could you tell us what you think a Heart Hero is?
- If this was available do you think you would like to become a Heart Hero?
What we learned
Here a selection of the most important comments that we derived from the user testing.
“The heart attack symptoms will be the most helpful area for me.”
– User #1
- Suggested Change – HIGH PRIORITY
- Change: make this section more prominent
- How might we… make this more of a key feature for our users? As a result of this comment, we decided to add additional structure to our originally proposed website. In the following section I created a sitemap that shows a clearer navigation, with Resources / Symptoms as the first section for users to explore.
“It’s still not clear to me what it means to be a member of a Heart Hub.”
– User #2
- Suggested Change – HIGH PRIORITY
- Change: Create a clear description with an infographic that can be communicated.
- Testing: This was particularly important for us to get right, therefore I redesigned our visuals and re-wrote our vision for what a Heart Hub stands for and its values. We organised additional testing for users of different ages, background and health priorities to read, digest and comment on the clarity of our new proposal.
“Some more media stuff about what to do if someone has a heart attack. A tutorial or a step by step guide.”
– User #3
- Suggested Change – LOW PRIORITY
- Change: This is an important change for us to consider, however as Service Designers we were conscious that we should not be responsible for creating a large amount of educational content.
- How might we… empower the members of any community to gain access to the training material needed in order to educate all women members?
- I created a flow diagram to incorporate a new feature to allow for members and organisers to request / book educational, medical or motivational speakers to attend a Heart Hub community meeting
Site structure
In order to get some feedback on our initial ideas, we originally did not spend too much time on planning the site navigation and information structure. After our user testing, I created this site structure to ensure that anyone using the responsive web app would within seconds understand the end-to-end Heart Hub service offering:
- Find useful information on heart health and making better life choices
- A user forum to ask any question and connect with others
- Become a member of an existing Heart Hub
- Start your own Heart Hub community
The agreed sections will be used to create the navigation on our mobile-first responsive web app.
Project summary
- Future opportunities:
- The next step of our project is to create a V2 mobile-first web application for the Heart Hub community. This will involve a prototype that include the new site structure and educational speaker booking system. This will then be tested with a new set of user testing participants
- In order to validate our hypotheses with measurable metrics, we would like to continue to the next stage of this project and roll-out a number of Heart Hub community pilot programs.
- As a group we have discussed the benefits of building an app that includes a positive life-changes tracking app and corresponding gamification feature to improve overall health and reduce heart disease and heart attacks.
- Key learnings:
- Being both a designer and a man, I faced some personal challenges in my mental dialogue throughout working on this women-centered project – my ongoing questions revolved around, “How can I effectively, directly and compassionately advise, propose and be an expert in this women-centered topic as a man?” I had to remind myself many times that I was here as a designer and not as a man. I often experienced this as a double bind as I’m a gay male and my husband and I live our lives through a very gender neutral lense. As a result I felt shame for the continual bias, inequality and mis-treatment created by other men, but then felt disconnected from both cis-gendered male and female communities being gay. I concluded that the project would have been easier if I had the ability to “switch off” any indication of gender, but as a result of my gender-neutral viewpoint I was able to strengthen my skills as an empathetic and compassionate Service Designer
- The trade-off of knowing the right level of information to be able to make informed decisions. We had to understand that we would never know everything about the project
- I repeatedly learned from our research participants who were older than me exactly how difficult it becomes to make small life changes. It is these small changes that can have a bigger impact over long periods of time and this is what our service is designed to encourage, support and grow
References
- https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
- https://www.escardio.org/The-ESC/Press-Office/Press-releases/Heart-attack-diagnosis-missed-in-women-more-often-than-in-men
Martin Gamble 
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