WomenToHeart: We want all women to be aware that they can have a heart attack, and be capable to communicate their symptoms early on and in their own words.
Project Sponsor: Student Service Design Challenge 2020, organized by Service Design Days, Philips Experience Design, IBM & Ellen McArthur Foundation
Project Outputs: Award-winning service concept WomenToheart, an online heart checkup tool to empower women to understand their early heart attack symptoms and communicate them via metaphors, rather than the traditional pain scale, as heart attack survivors intuitively do.
Team members: Ruchika Karnani, Maria Domeyko, Katerina Shikhotova, Angela Tam, and Laura Duarte. All UAL MA Service Design students
The Challenge:
How can we improve the heart health of people in Europe that are ‘invisible’, neglected, underserved, forgotten, or overlooked?. This was the brief given by the project sponsors to 35 student design teams from over 15 academies and universities that signed up for the design competition our team won. Besides a monetary prize, we won a 10 week design in residency at Phillips Experience Design to further refine our concept and a space to exhibit our concept at the Dutch Design Week 2020.
To start, we narrowed our focus down to women’s heart health, as we found shocking statistics that we, as women, were not aware of. The Student Service Design Challenge 2020 was divided into four main rounds, namely: 1) Identify & Explore, 2) Empathise & Discover, 3) Frame & Define and 4) Ideate & Develop. Each round was assessed by the jury from Philips, IBM, Service Design Days, and the Ellen McArthur Foundation.
My Role:
My previous leadership experience working remotely with international teams came in handy for this project. I took a leadership and project management role to make sure our goals were met within the deadlines. I also pushed for communication protocols and processes to avoid misunderstandings and delays, as Ruchika and Angela had thirteen hours of time difference between them.
I wanted to make sure everyone was on the same page, their opinions were heard and their inputs included. I thrive when I am in an environment where I can build on my colleagues' ideas, and they on mine, and when I can collaborate and not compete. For this project, we really worked as an ecosystem in harmony. I am extremely grateful to have worked with them.
Research Process:
We began the research process in January 2020. However, and as a result of the pandemic, our team of 5 moved back to their home countries, dividing us across four different time zones and 13 hours of difference between two members: Ruchika in India and Angela in Vancouver, Canada. This left us with very little time for synchronized teamwork. Our initial HMW was: How might we help women to recognize their heart attack symptoms and to seek help in a timely manner?. As we recently learned that heart attacks can happen to anyone, we knew we had to focus on women that had experienced heart attacks & understand their stories and pains to be able to use that knowledge to help other women.
Understanding the context and the systemic issue
Heart disease is the #1 killer of women in the UK, and kills twice as many women as breast cancer. However, only one in three women are aware of it as historically, heart disease has been perceived as a “male disease”.
Research surrounding heart disease in the medical community has primarily focused on men. Therefore, a comprehensive understanding of women’s hearts, especially when having heart attacks is limited. “Only one-third of cardiovascular clinical trial subjects are female and only 31% include results by sex”. As a result, diagnostic tools created by studying the symptoms and cases of primarily men are less effective to diagnose women’s heart attacks. Therefore, women are up to 3 times more likely to die following a serious heart attack than men as a result of receiving unequal care and treatment.
Women's heart attacks do not fit the stereotype of the middle-aged man suffering severe chest pain. Women's pain can be mild and they can often experience early warning signs for months. Moreover, slow-onset symptoms, such as indigestion, anxiety, nausea can present themselves months prior to the actual cardiac event
Identifying needs and challenges
Like everyone else, we were affected by the spread of COVID-19 and the prevalence of social distancing. It was challenging to set up face-to-face interviews, arrange visits to organizations and conduct ethnographic research. We knew our target group could be particularly vulnerable in the context of the current situation. Therefore, we decided to modify our plan and switched to digital environments:
By creating a wide range of digital cultural probes. We asked women and heart attack survivors to write a letter to their hearts, maintain a photo diary, fill in a journey map to identify habits and barriers towards identifying a heart attack, and understand what women wish to know about heart health. Not all the probes we were able to obtain results as this portion of the project overlapped with the first UK Lockdown. However, when we asked women to act out a heart attack, almost all of them clutched their chests and dropped to the floor. These are the classic “Hollywood symptoms” often showing up in the middle-aged.
By scouring the internet for women’s heart attack stories. We also used our social media to run surveys and conduct research and scoured the internet (youtube channels, blog posts, heart attack Facebook groups, and heart attack forums) for women's heart attack survivor stories and doctor’s testimonies. We analyzed these posts based on a set of questions that we created, in order to get as much information as we would in an in-person interview. Through this method, we were able to collect valuable information that we then validated with experts and women heart attack survivors we found later on in our research process.
In one of the interviews with Carolyn Thomas, a heart attack survivor and a mayo clinic certified heart advocate, told us the story of a woman she met who had been extremely exhausted and could not put together words to explain how she felt. When asked, she told her doctor that she was so tired to the point she could not even lift her laundry basket. This was the moment that her symptoms were heard.
Desk Research
Digital Ethnographic
Cultural probes
Interviews with experts & heart attack survivors
Key Insights
Women are unaware they can be at risk for a heart attack and how the symptoms could look like.
Women can experience non-chest-related symptoms that often overlap with non-life-threatening diseases, which results in women delay seeking help to avoid acting like a hypochondriac.
When looking for help, women struggle to communicate their symptoms effectively, tend to over-explain them, and underdiagnose themselves. However, some women have found effective ways to describe their symptoms through metaphors, rather than traditional pain scales.
Co-designing & testing ideas
Based on our research, we identified two areas of focus in which we could make an impact: awareness and communication. We decided to map the system as we thought all the issues were interconnected and ideate on service concepts that could address the entire system. We came up with all sorts of ideas from awareness campaigns, physical prompts, symptoms checkers, and collective intelligence platforms. To validate these ideas, we conducted competitive research to understand the solutions available.
We tested all our ideas with heart attack survivors and medical experts to let them choose which ideas they believed could help them to prevent a heart attack.
We had a breakthrough during one of the many in-depth interviews with Carolyn Thomas, who reminded us: “There will always be people doing awareness and there are lots of existing forums out there too, but there is no organization I’ve seen that is giving women tools to better communicate their symptoms.”. With this clear feedback, we decided to build on heart attack survivor’s collective intelligence and prototype and test a tool to help women to communicate their symptoms via metaphors. We tested with our partners and relatives, heart attack survivors, and doctors. We ended up with a few phrases that were effective to communicate how women felt, but also raised concerns from their partners, doctors, and relatives. We wanted them to say, “There is something wrong here, this is not the usual pain.”
System of issues affecting women when seeking help
Testing metaphors with doctors
Testing workshop
Testing metaphors with doctors
Project Outputs
A Digital Service:
Women to Heart is an online tool that helps women identify and articulate their symptoms through the use of metaphors. Our empowering approach helps women to understand their early warning signs and slow on set symptoms in order to seek help sooner.
“Ticks all the boxes from a highly relevant underserved population to a great concept and great storytelling”
Service Design Challenge Final Service Submission:
For the final stage of the competition we created a written report of our process, a video outlining our service, service blueprint, business model canvas and women to heart interactive prototypes for the jury to experience our service.
“The idea of not only thinking about physical health prevention but also embedding the elements of a community to connect and promote best practices makes it outstanding.”
Dutch Design Week
Part of our prize was to present our digital service concept at the Dutch Design Week, which had been moved online due to COVID-19. The first day of the design week, we shared our concept in a live interview with Sean Carney, Chief Design Officer at Phillips. We were able to share not only our concept, but our research process and a message for young designers.
“Well researched with input from many subject matter experts leading to a great ‘aha’ moment and problem to solve. The story of the problem and solution are well told and the tools and guidance provided in the product are a pleasure to use.”
Design in Residency at Phillips
Despite all the efforts made by the Phillips Team, COVID-19 forced us to have our design in residency fully online. Phillips's team put together a marvelous program to help us improve and elevate our concept. We received expert advice from more than 20 experts in product design, brand and communication, circular economy and data design from Phillips. Our design in residency wrapped up with the pitch of our improved concept “Hearticulate” to Phillips executives and an interview with Cardiologist Janneke Wittekoek,
Self Reflection & Learning Outcomes
Embrace Change: The pandemic hit in the middle of this project and our team of 5 moved back to their home countries, dividing us across four different time zones and 13 hours difference between two members. It was very difficult for us and we even talked about quitting. However, we decided to push forward and get more organized. We all had different skills that we put into service for the team. I was able to apply my experience leading remote international teams, project management, and leadership skills to keep the team on track, manage tasks, divide work and communicate effectively. I am proud of our team, that we were able to pivot so fast and adapt our team dynamics to the new reality while we were in the middle of a pandemic.
Think systemically: Being able to work on a very complex problem and find something small to take on and transform into an actual service, into something tangible; felt empowering to me. I felt like I could change the world. By applying our knowledge of service design tools, we were able to do something small that will empower women and hopefully save lives. This project was the mental reinforcement I needed to trust that I always can do something to change arbitrarily imposed realities.
Teamwork: Each one of us had different skills and we were able to complement each other and take on a role in the team. Despite the distance, we always found ways to keep ourselves connected and build on each other’s ideas using digital tools and creating communication protocols to make sure we were not doing double work. I also value so much our cultural differences and how that brought perspective to the team every single time.