Gender Aware PD Care 173 6 is expressed with less conversational engagement.44 These findings in line with the remarks of women in our study that the performance of certain social roles, such as active family care and household duties, can mask experienced difficulties with PD-related symptoms observed by others. Subsequently, this can lead to inaccurate evaluations of emotional and physical well-being of women with PD, intensify feelings of not being listened to or taken seriously and could explain why the women in this study described their need for- and use of more adaptive coping strategies compared to men. These examples are illustrations of a gendered pathway to health that can hamper women’s access to care and therefore increased awareness of these gendered performances and potential biases is needed among healthcare professionals. This could be assisted with active listening skills and additional probing during medical consultations to assess emotional and physical experiences of women with PD in a more detailed way.45 We support the ‘call to arms’ described by Subramanian et al (2022) that management of PD needs to be customised to include the unique stages and roles of women’s lifes.46 A strength of this study is the in-depth line of inquiry through our multimethod approach. For this present study, we applied an equity-centred design (ECD) approach that incorporates intentional reflectivity and that acknowledges power, identity and context in which the design process takes place.14,23 This multi-method participatory process includes patients in the research and design process and aims towards a practical translation of generated knowledge and insights. In a collaborative process, people with PD and health researchers worked together using cultural inquiry to understand patients lived gendered experiences, creative thinking to stimulate diverse perspectives and prioritise ideas related to gender aware PD care. It is useful to note that, in contrast to more traditional hypothesis-driven biomedical research, the designbased approach we employed in this study centres on understanding complex realworld contexts, aiming not to prove or reject hypotheses, but to comprehensively explore multifaceted issues and generate patient-driven recommendations through an iterative process of problem identification and solution co-creation. To our knowledge, there are still few design-based health research studies that directly address gender inequities that impact health and illness experiences.47–50 While humancentred design methodologies, such as the ECD approach used in this study, are often perceived as a single standardised method, their application, in fact, entails a wide array of qualitative, quantitative and design methods or techniques that can and should be used selectively, dependent on the specific research context.51 ECD practitioners in health research should carefully select the participatory methods they deploy, with sensitivity towards capturing the unique insights and capabilities of each participant
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