Sex representation and user preferences in pain drawing body charts in back pain research: New publication in JMIR Human Factors
Many clinical and research decisions rely on tools that are assumed to be sex neutral, yet their design is rarely examined.
Our new open-access study in JMIR Human Factors, in connection with Digital Health Zurich and funded by DIZH, takes a closer look at pain drawing body charts, a standard method used for decades to assess and communicate back pain.
Across 108 studies, we found that:
- 95% did not report the sex of the body chart used
- Only 5.6% included both male and female versions
- Nearly two-thirds of charts were male-biased, often used in populations that included both sexes.
We also observed that many charts likely intended to be neutral were nonetheless perceived more often as male, reflecting how ambiguity in design can reinforce default assumptions. To address this, we developed and evaluated a sex-neutral body chart. It was perceived as sex-neutral by 68.5% of participants and was broadly accepted across sex, age, and education levels. At the same time, differences in perception across racial groups highlight the importance of cultural considerations in the design of clinical and digital health tools.
These findings underscore a broader implication for research and practice: Improving equity in health evidence is not only about who we include, but also about ensuring that the instruments we use to measure health are inclusive, transparent, and appropriate for diverse populations.