General Discussion 215 8 A recent study highlighted the importance of adding more gender awareness in designbased studies in healthcare.15 The author argued that there is a lack of understanding and awareness of gender in design research and how gender norms and stereotypes can impact the development, use and perception of products, systems and services that are designed with these methodologies. Particularly in the design of health interventions, culturally established gender norms can either be reproduced or deconstructed. A recent systematic review on ‘disrupting gender norms in health systems’ emphasized the need to systematically identify and address restrictive gender norms that lead to gender inequalities in health systems.16 Only four of the 76 included studies used a clinic-based gender transformative approach that effectively challenged and addressed restrictive gender norms and showed significant health impact.17 These interventions were primarily focused on the empowerment of women and girls. This review reported that, due to the historical legacy of gender-based inequalities, the health consequences fall most heavily on women, especially poor women. However, restrictive gender norms and stereotypes undermine the health and wellbeing of women, men and gender minorities and effective promotion of gender equality in health required the engagement of actors of all gender identities.10 Moreover, the review concluded that the data did not support a particular gender transformative intervention as a ‘silver bullet’ that will work in all contexts. Gender norms and inequalities are highly contextual and rather than seeking to make gendered interventions universally generalizable, design researchers should recognize the value of their contextual nature and identify program elements that could work alone or in combination, depending on the context and intended health outcomes. Stewart et al. (2020) identified effective strategies to challenge and address gendered norms and stereotypes in the design of health interventions, such as increasing knowledge of gendered norms and stereotypes, addressing multiple dimensions of gender during the design process, co-designing interventions with participants of the target population and cultivating agents of change and role models.18
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