Earlier this month, I had the pleasure of hosting a panel at the inaugural Women’s Leadership Summit at the University of California, Irvine. The panel was entitled “Womxn Talk Tech”, and brought together a wonderfully diverse group of women working in technology to discuss their experiences in the industry. As we made our way through an ambitious agenda, one theme stood out to me in particular: the idea of tokenism in the workplace.
In the context of the panel, this refers to being the “token” woman on a team, but tokenism may be present in many other contexts; it is, by definition, the practice of making only a symbolic effort to include minority groups, in order to give the appearance (rather than the reality) of equality. While “diversity & inclusion” are now popular buzzwords in the workplace, often used interchangeably, I think of tokenism as diversity without inclusion. Inclusion goes beyond simply hiring diverse groups; members of those diverse groups must have equity and feel valued and welcomed, regardless of their background.
In the weeks since the panel, this discussion of tokenism stuck with me and I started to think about how this applies to the development of digital health. While it’s not enough to hire members of a minority group and say “Hey look, we’re inclusive!”; in the same vein, it’s not enough to say you’ve designed an app for a minority group and proclaim “This is inclusive design!”
Inclusive design focuses on the diversity of people and how this diversity impacts design decisions. Inclusive design is not synonymous with universal design; it does not suggest that it’s always possible, or appropriate, to address the needs of the entire population with one product. Instead, inclusive design focuses on choosing an appropriate target audience for a product, and making informed decisions to maximize the benefit for that audience. Every design decision has the potential to include or exclude users. Examples include font choices, which may exclude those with additional learning needs or cognitive dysfunction, or language; an app which uses gendered language excludes anyone who does not identify as that gender, and an app in English excludes those who use another language. There are many ways to be more inclusive in the design process; here I’ll talk about just three of them.
First, it’s important that health apps are tailored to the needs of the target population in a relevant way. Not all tailoring, however well-intentioned, is appropriate. We see examples of this with period-tracking apps: using design attributes or a color scheme which have been socially constructed to represent femininity (e.g. flowers, pink) does not an inclusive app make. These design choices can in fact serve to alienate target users, as shown in a recent analysis of menstrual tracking apps, where one participant stated that “a lot of [period tracking apps] just felt kind of condescending or like they were designed by dudes who were designing what they thought a woman would like.”
Inappropriate tailoring could be more easily avoided if members of the group the app is designed to serve contribute to the design process. This brings me to my second point: in order for design to be inclusive, the voices of end-users must be heard and considered, through participatory or co-design. Developers can gain unique insights into alternative perspectives and individual experiences through stakeholder engagement. Take the use of color as an example: in mood-tracking apps, color may be used to represent different moods, feelings or mental states. Colors carry different meanings for different cultures — for example, red can symbolize anger or danger in Western cultures, but have more positive associations with happiness and celebration in Asian cultures. These associations, which have significant design implications, may be overlooked if developers do not expand their design process to include perspectives from a range of diverse stakeholders.
Finally, developers should be cognizant of issues of intersectionality. Identity markers like race, age, ability, gender identity and sexual orientation do not each exist in a vacuum, and often intersect to create additional challenges. Try to be mindful of the complex and diverse needs of your target group. Going back to our period-tracking apps: these apps often use gendered language, excluding non-cisgender users, or take a heteronormative approach to sexual and reproductive health, excluding queer folk. Apps are not inclusive simply because they are targeted at an underrepresented or underserved community; we often see resources for the LGBTQ community, for example, which cater solely to white people and ignore the perspectives of people of color.
There’s no quick fix to the issue of diversity without inclusion, but developers can help make more inclusive products when they are curious, ask questions, and most importantly, engage with their stakeholders.