Working women's perceptions and expectations of digital health tools for personal health management: A qualitative study

Abstract

Aim

This study examined the health challenges experienced by women in physically and mentally demanding occupations, including healthcare, shift work, night work and education. It explored their digital health technology use and expectations for future advancements to support their well-being.

Methods

In this qualitative study, semi-structured interviews were conducted with 17 full-time working women aged 20 to 64 years, employed in occupations including baking (manufacturing), long-distance truck driving (transportation), cabin crew (aviation), nursing and midwifery (healthcare), teaching (education) and local-level politics. Participants were recruited through purposive sampling. Data were collected via Zoom between June and August 2024. Content analysis identified key themes related to health issues, workplace barriers, use of digital health tools and desired features of future technologies.

Results

Participants reported physical and emotional symptoms associated with menstruation and hormonal changes, often worsened by inadequate workplace support. Despite widespread interest in digital health tools such as smartwatches and menstrual tracking apps, adoption was limited due to workplace restrictions, data security concerns, usability challenges and app fatigue. Desired features included simplicity, personalisation and seamless integration into daily routines. Participants emphasised that effective digital health technologies must be accompanied by organisational support and inclusive workplace policies.

Conclusion

These findings highlight the urgent need for digital health solutions tailored to the realities of diverse working environments. By incorporating users’ lived experiences, particularly from underrepresented occupational sectors, this study offers practical insights into the structural and functional requirements for successful adoption. Collaboration between developers, employers, and policymakers is essential to deliver equitable, secure, and effective digital health support for working women.

Introduction

Since the implementation of Japan's Equal Employment Opportunity Law in 1986, there has been a substantial rise in the employment rate among women aged 15 to 64 years. ¹ This rise is attributed to changes in perceptions held by both women and society regarding women's roles in the workforce. ² Consequently, the legal system has been strengthened to support women in balancing work and child-rearing, with improvements in childcare infrastructure such as childcare centres and childcare leave systems. ³ By 2023, women's employment rate had steadily increased, reaching 73.3% for those aged 15 to 64 years and 80.8% for those aged 25 to 44. ⁴ In Japan, the labour force participation rate of women, defined as the percentage of women aged 15 years and older, was 55%. Although this rate remains lower than that of Scandinavia and Oceania, it ranks mid-range among Organisation for Economic Co-operation and Development (OECD) countries and is not significantly different from that of other member nations. ⁵

However, despite the increase in Japanese women's labour force participation, social norms and institutional policies in Japan remain inadequate. ⁶ Many women continue to struggle with balancing career aspirations and family responsibilities. In most other countries, the proportion of women in managerial positions is 30% or higher, while in Japan it is only 14.6% – a comparatively low figure. ⁷ Additionally, the Global Gender Gap Report 2024, which evaluates gender inequality using national statistics, ranks Japan 118th out of 146 countries – the lowest among the G7 nations. ⁸ These data indicate that the gender gap in Japan persists, particularly within the political and economic sectors.

A major reason for women's low representation in management positions is the enduring influence of traditional gender roles in Japanese society, where women are expected to take primary responsibility for household and child-rearing duties. ⁹ This cultural norm often poses challenges for women striving to balance domestic responsibilities with their professional careers, diminishing their motivation to pursue or remain in management roles. ¹⁰

Recent trends report that a growing number of women in their 40s and 50s are stepping down from management positions due to menopausal symptoms, including depression and declining physical health. ¹¹ Unlike men, women undergo substantial hormonal changes throughout various life stages. ¹² During puberty, menarche triggers increased hormone secretion, which stabilises in adulthood to support reproductive functions such as pregnancy and childbirth. In the mid- to late-40s, women experience a rapid decline in hormone levels over a 4- to 5-year menopausal transition, leading to a non-reproductive state. These hormonal fluctuations have significant implications for working women. Surveys indicate that menstruation- and menopause-related symptoms, including physical discomfort and psychological distress, adversely affect their work performance.^13–15 Additionally, certain professions – such as healthcare, shift work, night work and education – impose substantial physical and psychological demands, making individuals in these fields particularly susceptible to chronic fatigue.^16–18 These challenges underscore the importance of adopting a life-course perspective on women's health, recognising that physical and psychological demands fluctuate across stages such as adolescence, reproductive years and menopause.

In recent decades, the internet of things (IoT) and applications (apps) that manage and support women's health have gained significant attention. ¹⁹ Various IoT devices – including smartwatches, smart rings, smart clothing and smart glasses – have been developed, alongside a wide range of apps designed to encourage behaviour change. The global FemTech market, comprising technology-driven solutions tailored to women's health needs, is also rapidly expanding. ²⁰ These technologies have demonstrated potential to improve access to medical services, enhance maternal health, deliver targeted health information and promote women's autonomy. In recognition of these benefits, the World Health Organisation (WHO) has highlighted digital health as a promising tool for improving women's health and advancing gender equality. ²¹ As health experiences vary significantly by life stage and occupation, there is a growing need for flexible and responsive health solutions. Digital health technologies hold considerable promise for supporting women across different phases of their working lives.

However, existing research has largely focused on reproductive outcomes such as pregnancy complications and miscarriage risks, particularly in relation to occupational stress and shift work.^22,23 Additionally, although numerous studies have explored the relationship between shift work, extended hours and cancer risk, these have predominantly targeted long-shift workers and medical professionals.^24,25 While long working hours are well known to contribute to fatigue, sleep disorders and stress, there is limited research on how women in non-medical yet physically and mentally demanding occupations manage their health, or how digital health technologies are perceived and used in these real-world contexts.^26–28 Moreover, most studies have evaluated the clinical effectiveness or technological development of these tools, but few have examined their real-world usability, cultural acceptability or integration into the daily routines of working women across diverse sectors. This constitutes a critical research gap. Despite growing global interest in FemTech, there is a notable lack of evidence on how working women perceive, adopt and utilise these digital health tools in the context of their everyday occupational environments.

Globally, women's participation in physically and emotionally demanding industries – such as logistics, service and care work – is rising. While the promise of digital health tools has been recognised internationally, their actual adoption and impact vary depending on context. Japan presents a particularly relevant case: despite its advanced technological infrastructure and relatively high female employment rate, gender-based health and occupational inequities persist. Therefore, studying Japanese women's experiences with digital health technologies offers insights that are globally transferable, particularly to similarly industrialised societies facing structural gender disparities.

Given the increasing prevalence of digital technologies and the persistent health and occupational challenges faced by working women, there is an urgent need to investigate how these tools are currently being used and whether they adequately meet the needs of this population. Such knowledge is essential for informing the development of more inclusive, effective and context-sensitive digital health solutions. This study adopts a life-course and occupational lens to examine how women in various age groups and professions perceive and utilise digital health tools. By including full-time workers from their 20s to 50s, the study captures both stage-specific and shared health experiences in the workplace.

To address this critical gap, the present study aimed to explore how full-time working women in high-stress environments perceive and use digital health technologies – including wearable devices such as smartwatches and health-related mobile applications – and to identify their specific health challenges and unmet needs.

The objectives of this study are:

to identify the unique physical and psychological health challenges experienced by working women in high-demand environments;

to explore their current use and perceptions of digital health technologies and

to clarify their expectations for future advancements in health-supportive digital tools tailored to women's needs.

By capturing the lived experiences of working women, this study seeks to generate foundational insights that can guide the design and implementation of digital health interventions that are responsive, equitable and practically useful in real-world occupational contexts.

Methods

Study design

To gain detailed insights into working women's perspectives on digital health, a qualitative descriptive method aligned with the study objectives was adopted. One-on-one semi-structured interviews were conducted with full-time working women. An a priori indicative sample size of approximately n = 12 was determined, based on an Australian study investigating women's engagement with digital health and comprising 12 individual interviews and three focus groups (total n = 13). ²⁹ While the Australian study adopted a mixed data-collection approach, the present study utilised exclusively in-depth, one-on-one interviews to elicit rich narratives in a confidential setting. To ensure heterogeneity while permitting within-domain comparison, recruitment targeted 2 to 3 participants from each occupational domain included in the sampling frame.

Data collection and analysis proceeded iteratively, and recruitment continued until analytic saturation was reached. Saturation was operationalised as the absence of new codes or themes in consecutive interviews and the stability of the coding framework across occupational domains. This threshold was reached after n = 17 interviews; thus, the final sample reflects the point at which additional interviews no longer yielded novel conceptual insights despite cross-domain comparisons.

In this study, the assessment of saturation was also supported by the study scope – focusing on working women in physically and mentally demanding occupations – and by diversity in age, job type and work environment. The recurrence of key themes among participants indicated that the core issues had been adequately captured.

This study was grounded in a constructivist paradigm, which assumes that reality is co-constructed between researcher and participants through dialogue. This philosophical stance was appropriate given the aim to explore the lived experiences and individual perceptions of working women regarding digital health technologies. To enhance reporting rigour and ensure methodological transparency, the study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist ³⁰ (Supplemental File 1). The data were analysed using content analysis, a widely used method in descriptive qualitative research, ³¹ which enables the systematic interpretation of textual data by classifying and coding narrative content into categories and themes. ³² It is particularly suitable for exploring both manifest content (explicitly stated) and latent content (underlying meaning), allowing for a nuanced understanding of participants’ perspectives. ³³

Themes were derived inductively from the data. A coding framework was collaboratively developed and iteratively refined through team discussions during the analytic process, although the complete coding tree was not included in the manuscript. To strengthen credibility and confirmability, an audit trail was maintained, and reflexivity was ensured through repeated discussions among researchers with diverse professional backgrounds. Multiple researchers were involved in coding and theme development, and discrepancies were resolved through discussion to reach consensus. Participants did not review or provide feedback on the findings.

The interview guide was developed based on an existing framework from the aforementioned Australian study exploring women's engagement with digital health technologies. ²⁹ It consisted of open-ended questions and surveys organised into three sections: (1) health problems and symptoms, including work-related issues; (2) use of digital health technologies for prevention or treatment, with participants asked to describe any technologies they had used and (3) participants’ preferences and expectations for future digital health technology developments. To enhance contextual appropriateness, a pre-test was conducted on 9 February 2024 with six Japanese women who attended a FemTech-related event. Feedback from the pre-test informed minor revisions to wording and structure. Follow-up questions were tailored in response to participants’ varied answers during the interviews. The interview guide is available in Supplemental File 2.

Participants and setting

This study employed purposive sampling to recruit full-time working women aged 20 to 64 years employed in night shifts, irregular hours or highly stressful jobs. Participants represented a wide range of professions, including bakers (manufacturing), long-distance truck drivers (transportation), cabin attendants (aviation), visiting nurses and midwives (healthcare), teachers (education) and politicians (public service). Two recruitment methods were used: kinship recruitment through the researcher's personal contacts and web-based recruitment via a research company with Japan's largest survey panel (comprising approximately 10 million respondents). For the web-based recruitment, a preliminary online screening survey was conducted to assess eligibility based on occupation and age. Eligible participants were then asked to complete a questionnaire covering demographic and work-related characteristics – including marital status, presence of children, work history, years of employment – and their experience with digital health technologies, including the types of devices and applications they had used. Those who met the eligibility criteria and provided consent were invited to participate in the semi-structured interviews. To minimise selection bias and undue influence, recruitment procedures excluded individuals with prior supervisory or reporting relationships. Study materials highlighted the voluntary nature of participation and assured confidentiality. Purposive maximum-variation sampling was employed to target heterogeneity across age, occupational domain and work environment, with a target of two to three participants per domain.

Ethical considerations

This study was approved on 5 January 2024 by the Research Ethics Committee of the National Center for Global Health and Medicine (approval number: 004790). Prior to the study, all participants received a copy of the research protocol via email or post and provided their consent to participate. To ensure anonymity, each participant was assigned an ID number. All participants received a USD 7 shopping coupon as compensation.

Data collection

Data were collected between June and August 2024 via Zoom, with participant identities verified before each session. The sessions were digitally recorded and transcribed verbatim by a professional transcription service with the participants’ consent. The interviews were conducted by the principal investigator, KS, who holds a PhD in International Nursing. The interviewer underwent formal graduate-level training in qualitative research and had prior professional experience in the conduct of semi-structured interviews. There was no prior relationship between the interviewer and the participants before the commencement of the study. Prior to each session, participants were informed of the interviewer's name, institutional affiliation, and the purpose of the study. No participants withdrew or refused to participate after providing consent. The one-on-one interviews were conducted in the absence of any additional persons. Each participant was interviewed once, with no repeat interviews conducted. Field notes were taken during the interviews to document the participants’ facial expressions, tone of voice and other non-verbal cues. The interviewer also recorded her own impressions and preliminary analytical insights, including emergent hypotheses, immediately following each session. These notes supported reflexive analysis and contributed to theme development. The transcripts were not returned to the participants for comment or correction. Each session lasted approximately 40 to 60 minutes, with an average interview duration of 37 minutes.

Data analysis

The transcripts were reviewed for accuracy by one of the researchers. Interviews continued until data saturation was achieved, meaning no new information emerged from subsequent interviews. Data were analysed using an inductive approach. ³² Two independent researchers (KS and TS) collaboratively coded multiple transcripts and developed a shared coding framework, drawing on their extensive experience in qualitative interview analysis. Once the framework was established, a third researcher (YE), also experienced in qualitative research, supervised the process. The three researchers discussed the codes and resolved discrepancies through dialogue. The coding framework was further refined through discussions involving the entire research team. Data were analysed using MAXQDA software (version 24), which facilitated efficient organisation and management of codes. ³⁴

Results

A total of 17 women working in physically and mentally demanding occupations participated in the study. The participants represented a wide range of professions characterised by long working hours, irregular schedules, or high levels of physical and emotional strain. They included manufacturing workers and bakers, both of whom spend long hours standing; nightclub hostesses engaged in night-time entertainment and prolonged standing; long-distance truck drivers working overnight shifts; cabin attendants on international flights; postal workers spending extended daytime hours outdoors; midwives working night shifts; visiting nurses with irregular working hours; teachers frequently working on weekends; and politicians with no fixed days off. Participants were recruited from various regions across Japan, including Kanto, Kansai, Chubu and Kyushu, covering both urban and rural areas. Ages ranged from 23 to 54 years, with a mean age of 37.2 years. Regarding family background, eight participants were married, and seven had children, reflecting a spectrum of family responsibilities alongside their occupational demands. Years of service in their respective occupations ranged from 1 to 30 years. While some participants, such as nurses and teachers, were early-career professionals, others had over two decades of experience, particularly those working in sectors such as logistics, politics and hospitality. In terms of digital health experience, 14 participants reported using digital health tools such as smartwatches, health-tracking applications or menstruation management apps. Several had used these tools for over five years, and some for more than a decade. Conversely, three participants reported little or no prior experience with such technologies.

Data saturation was considered achieved, as no new themes or categories emerged during the final stages of data collection and analysis. The interview analysis yielded 988 initial codes, which were organised into 15 categories, 134 sub-categories, and 5 overarching themes reflecting participants’ perspectives on digital health technology. The five themes were: (1) perception of current health problems and challenges specific to women; (2) personal health perception; (3) experience of using digital health technology for health management; (4) consideration and support for women in the workplace and (5) perception of digital health devices.

Detailed sub-categories and representative examples for each theme are provided in Supplementary File 3. The data and findings demonstrated clear consistency, as each theme was supported by illustrative quotations from the participants.

Theme 1: Perception of current health problems and challenges specific to women

This theme highlights women's health concerns, particularly during menstruation. Participants reported physical pain, fatigue, emotional distress, and challenges in managing menstruation, such as unpredictable cycles and limited access to facilities for changing sanitary products. Workplace demands and a lack of support often forced women to work through discomfort, making menstrual health management particularly difficult. Details related to this theme are presented in Supplemental Table 1.

Health problems before and during menstruation

The interview began with contextual questions asking participants about general health issues and those specific to women. Regarding health problems before and during menstruation, approximately half of the participants reported experiencing headaches, back pain and ovulation pain (n = 8). These symptoms were accompanied by abdominal pain and sluggishness, which made movement difficult (n = 6).

‘I often suffer from severe headaches and lower back pain. While medication offers slight relief, I also feel extremely fatigued. Because I work in an environment with many women, I assume everyone else silently endures the same issues. This makes it difficult to say something like, “It's due to menstrual pain”. So, I end up working through it without speaking up, which can be very tough’. (ID 12)

In addition to these physical symptoms, participants noted significant irritability, contributing to heightened distress (n = 5), along with unexplained emotional fluctuations characterised by mood swings and depressive feelings (n = 3). Some participants also reported a rapid increase in appetite and sudden drowsiness. Others mentioned feeling generally unwell, experiencing dry skin due to hormonal imbalances, and, in some cases, missing their menstrual cycles due to stress.

Difficulties related to menstruation

Many participants expressed difficulty in changing sanitary products when needed due to work-related constraints (n = 7).

‘Menstruation can be quite challenging. On top of that, I often don’t even have time to go to the restroom, so I can’t change my pad right away. When my flow is heavy, I spend the day feeling a bit anxious. I try to go to the restroom whenever I can, but since I can’t leave the students unattended, I probably change my pad less frequently than others’. (ID 15)

Several participants also mentioned the unpredictability of menstruation (n = 4), making it difficult to adapt to changes in their work environment or responsibilities during that time (n = 4). Additionally, multiple participants highlighted the challenges of managing leaks resulting from heavy menstrual bleeding (n = 3).

Problem of forcing oneself to adapt to workplace demands

A strong workplace culture of responsibility prevented participants from taking leave, even when experiencing health issues (n = 3).

‘I rarely hear anyone say they’re taking time off due to menstrual pain. Perhaps if the pain were unbearable and medication didn’t help, people might take a day off. But most people seem to just take painkillers and go to work, acting as though everything is fine’. (ID 3)

Beyond this sense of duty, concerns about income loss from unpaid leave also discouraged participants from taking necessary time off (n = 2). Additionally, in male-dominated environments, discussing women's health concerns was difficult, with limited support or adjustments offered (n = 2). A few participants expressed frustration over challenges in scheduling leave for fertility treatment/related issues, while one noted that menstrual-related leave was neither recognised nor accommodated in their workplace. Another described feeling unable to take leave during menstruation due to concerns about inconveniencing co-workers.

Theme 2: Personal health perception

This theme highlights how personal health awareness differed among participants. Some became more health-conscious after recognising poor habits or external influences, while others maintained small but consistent health practices. However, many participants placed a lower priority on health management due to busy schedules, opting for rest over exercise or feeling constrained by other responsibilities – highlighting diverse attitudes towards health. Details related to this theme are presented in Supplemental Table 2.

Health management initiated by specific motivational factors

Some participants reported a sudden awareness of their deteriorating health, which they attributed to their unhealthy daily routines (n = 3), while others became aware of health risks through annual medical check-ups and subsequently began exercising (n = 2).

‘I became more health-conscious during the COVID-19 pandemic. A friend who plays futsal invited me, saying something like, “If you’re always at home, why not come join us?” At that point, I hadn’t been out or exercised for nearly a month. When I explained that, they bluntly said, “You’ve got legs that never get used”. That irritated me, so I started going to the gym, got genetic testing, and even had a full medical check-up’. (ID 7)

Additionally, some participants in healthcare professions reported becoming more attentive to their own sleep and dietary habits after acquiring medical knowledge (n = 2). Participants also reported discovering a gym during a business trip and taking up exercise primarily because they had nothing else to do (n = 2).

Desire to maintain a health-conscious lifestyle

Although limited in number, some participants maintained health-conscious lifestyles without any specific motivation to become healthier (n = 2).

‘To manage my health, I do what I can—such as eating well and getting enough sleep’. (ID 8)

These participants did not invest significant time or money but engaged in small, routine habits to maintain their health. However, they did not report experiencing any discernible benefits.

Low priority on exercise and diet management

Some participants in their 30s and 40s reported that due to their busy work schedules, they preferred to rest rather than exercise on their days off (n = 4).

‘I used to go to the gym frequently, even on weekends. But after moving to an area without nearby gyms, and especially after starting to live with my husband, I now prefer to just relax at home’. (ID 9)

Additionally, some participants in their 20s stated that they did not currently perceive a need to engage in extensive health management (n = 3).

A minority of participants reported that even if they wanted to exercise, responsibilities such as housework and childcare occupied them to the extent that they were unable to prioritise their own health (n = 2).

Theme 3: Experience of using digital health technology for health management

This theme highlights how participants engaged with IoT devices and mobile applications to monitor physiological metrics such as heart rate, step count and menstrual cycles. Many began using these tools based on recommendations or to meet personal needs, such as pregnancy planning. However, barriers included workplace restrictions, limited awareness of available products, or misalignment with personal habits and time constraints. Common reasons for discontinuing use included the complexity of data input, feeling demotivated by app feedback, or questioning the tool's effectiveness. Details related to this theme are presented in Supplemental Table 3.

Purposes of using IoT devices and apps

The most frequently used apps included the iPhone Health app, Sleep Master for sleep management, the Lunaruna menstrual cycle tracking app, and Garmin devices for monitoring physical activity and sleep. Of the 17 participants, three had never used any digital health apps. Among those who did, menstrual cycle tracking apps were primarily used by participants in their 30s (n = 4). Apps for monitoring pulse rate and step count were commonly used by participants in their 20s (n = 4) and 30s (n = 4). Participants in their 40s and older (n = 5) tended to use apps to track and analyse accumulated health data rather than checking individual values.

Many participants using IoT devices tracked their daily pulse rate and step count (n = 11), recording and analysing this data to assess their overall health (n = 8).

‘I use an Apple watch synced with the health App on my iPhone. Since I’m not allowed to wear it while working, I check my step count on my days off to see how much I’ve walked’. (ID10)

Across all age groups, menstrual cycle management apps were commonly used to predict upcoming cycles and plan accordingly (n = 7). Among these, three out of seven users were in their 30s. A key motivation for using these apps was to visualise health data through consistent tracking (n = 6). Additionally, some participants used apps to log step counts and redeem accumulated points for rewards such as coffee vouchers (n = 5). While less common, apps were also used specifically to receive positive feedback reinforcing healthy habits (n = 1).

Reasons for starting to use IoT/Apps

When asked how they began using IoT devices, many participants reported developing an interest following recommendations from others (n = 4).

‘Many people around me use Apple watches, and my company encourages us to use apps that track our steps’. (ID 6)

Some participants indicated they started using apps because they offered functions that aligned with their personal needs, such as aiding in pregnancy planning or tracking their menstrual cycle (n = 3). Additionally, several participants indicated that the apps suited their lifestyle, which influenced their decision to start using them (n = 3).

Reasons for not using IoT/Apps frequently or at all

Reasons for infrequent or non-use of IoT/apps included occupational restrictions. Professionals such as nurses, cabin attendants, and hostess bar staff were prohibited from using devices such as mobile phones or Apple Watches at work (n = 5).

‘I know about the Apple Watch, but as a teacher, I feel hesitant to wear something so expensive. I also think many people around me don’t wear one either’. (ID 15)

Additionally, five participants reported not using IoT/apps because they were unaware of the available products. Four others indicated that the operation of IoT devices/apps – such as the transmission of photos or entering detailed data – did not align with their personality or lifestyle, particularly given their limited time.

Reasons for discontinuing the use of IoT/Apps

This category primarily reflected a mismatch between the apps and users’ preferences, particularly due to the burden of daily data entry and a sense of being judged for not exercising (n = 6).

‘My husband takes photos of his food every day and logs them into an app. He's very diligent about it. Even when I tell him to eat quickly, he insists on taking a picture first. I find that surprising. I could never do that myself. The app gives advice – like suggesting what to eat or pointing out what I’m missing – but I don’t like being told what to do. I tend to lie when I feel monitored. If I eat bread, for example, I won’t log it in the app. Eventually, I just stop using it’. (ID 1)

Additionally, some participants mentioned discontinuing IoT/apps if they found them ineffective (n = 2), or because they did not want to manage multiple apps at once (n = 2).

Theme 4: Consideration and support for women in the workplace

While some companies offered health support systems for women, such as career consultations and female-specific health checks, most lacked such mechanisms, and menstrual leave was rarely prioritised. Even in workplaces offering supportive policies, participants often hesitated to utilise them due to concerns about understaffing or burdening colleagues. Although some participants reported positive experiences accessing leave or support, these were uncommon, highlighting the need for more practical and accessible workplace health support systems for women. Details related to this theme are presented in Supplemental Table 4.

Support system for women employees in companies

Some participants were employed by companies that had systems in place to support the health of women employees; however, the majority did not, and such support was rarely mentioned in the interviews (n = 4).

‘A colleague of mine had scheduled an egg-freezing appointment for the weekend but had to cancel because she was called into work. It's such an important procedure, yet the workplace didn’t prioritise it. At her previous job, she could take time off immediately if she had a medical certificate. But in our current field, it's almost impossible. She said she wishes there were more support for women – things like menstrual leave are rarely even considered’. (ID 13)

In a small number of cases, financial support included career consultations and women's health check-ups (n = 2). However, welfare benefits specifically designed for women were almost never mentioned (n = 1).

Ease of utilising health support systems for women employees

Some participants noted that even with systems in place to support women's health within their companies, utilising these systems remained challenging (n = 3). For instance, they mentioned being unable to take time off during their menstrual periods due to concerns about slowing down work in already understaffed workplaces.

‘In my workplace, there's no stigma against taking menstrual leave. Everyone is supportive and says it's fine. It's a great environment. But because we’re short-staffed and I’m a teacher, it feels like taking time off would inconvenience the students. So even though the policy exists, I perceive using it negatively’. (ID17)

Positive comments were also shared, highlighting the ease with which women in some workplaces could take time off, although such experiences represented a minority of cases (n = 1).

Theme 5: Perception of digital health devices

Participants expressed high expectations for future devices, emphasising simplicity in data input, clear and customisable feedback, and multifunctionality to reduce the need for multiple apps. Preferences included non-intrusive wearables such as devices worn on the arm or finger, and tools whose cost could be justified by their functionality. However, some participants found digital health solutions impractical or inadequate for addressing their needs. Concerns included the inconvenience of data entry, doubts about tool effectiveness, privacy risks, and the stress of constant monitoring. Fears of workplace repercussions from using fertility apps also highlighted the need for greater trust, confidentiality and user-centred design in these technologies. Details related to this theme are presented in Supplemental Table 5.

Expectations for future digital health devices

Many participants in their 30s and 40s expressed expectations for future digital health devices to include features such as health and fitness tracking, calorie logging, physical condition monitoring, calorie expenditure tracking, medication reminders and beauty management functions. To visualise these generational trends, Figure 1 presents a heatmap segmented by age group (20s, 30s, 40s and 50s+), indicating the number of participants within each group who mentioned specific desired functions. The numbers within each cell represent the participant count, while the colour intensity reflects the frequency of mentions – darker colours indicate a greater number of participants expressing that expectation. This visualisation highlights that participants in their 30s and 40s reported greater expectations for future devices than did other age groups.

Figure 1.

Heatmap of expectations for digital health device development by age group (number of mentions).

Ease of data input was considered essential, along with clear, logically organised data displays (n = 7). When receiving feedback on their input, participants demanded options to adjust the frequency and detail of feedback, or to customise it to suit their preferences (n = 5). While IoT devices vary in form, some participants expressed a preference for wearable devices on the arm or finger that would not interfere with sleep (n = 4). Others highlighted the importance of devices being cost-justified and capable of consolidating functions into a single platform to reduce reliance on multiple apps (n = 4).

Unclear and vague impressions of digital health devices

Some participants expressed uncertainty about the availability of devices or apps capable of addressing their specific health problems, even when such technologies existed (n = 4). Several noted the challenge of identifying relevant apps for health management in daily life. Additionally, some participants expressed that while advanced IoT technology is available, envisioning practical and usable apps for their needs remains difficult (n = 2).

Discomfort regarding the use of devices

Negative views were also expressed regarding digital health devices and apps. Common concerns included ‘Taking photos and entering data is troublesome’ (n = 4), ‘App-based management is undesirable’ (n = 3), and ‘Doubts about functions and effectiveness’ (n = 3). Further concerns were raised about the potential health effects of devices, such as those linked to light sensors and other embedded technologies, as well as fears of data breaches and information leaks. More critically, one participant worried that using fertility apps or devices might negatively affect their career prospects if discovered by their employer. Others voiced a reluctance to be ‘managed’ by apps and shared concerns about the stress caused by receiving constant notifications or feedback.

Discussion

This study explored the unique health challenges faced by 17 women working in high-demanding environments characterised by night shifts, irregular schedules and high-stress occupations. The researchers selected participants aged between 20 and 55 years to reflect a broad spectrum of reproductive and occupational health concerns, including menstruation, fertility, pregnancy, and early menopausal symptoms. The findings revealed significant physical and emotional symptoms associated with menstruation and hormonal changes, including abdominal pain, irritability, fatigue and mood swings. Furthermore, cultural and structural workplace barriers – such as inadequate sanitation facilities and limited opportunities to address health concerns – were found to exacerbate these issues, underscoring the urgent need for targeted workplace interventions.

Women's health problems and workplace barriers

Participants reported a range of physical symptoms, including severe menstrual pain, headaches, and fatigue, which frequently impaired their work performance. Emotional symptoms such as irritability and mood swings compounded these difficulties. These problems were particularly pronounced among women working in high-stress sectors such as healthcare, education and politics, and those with irregular working hours. A national survey of 2166 Japanese women similarly found that 28.6% experienced severe menstrual pain, with stress identified as a significant contributing factor. ³⁵ These findings align with prior research highlighting how workplace stress exacerbates women's health challenges.

Despite the provision of Japan's Labour Standards Act, Article 68, which mandates menstrual leave, participants in this study frequently expressed reluctance to utilise it. Contributing factors included concerns about negative perceptions from colleagues, feelings of guilt and the fact that menstrual leave is often unpaid. While 70% of large Japanese companies (with 300+ employees) formally implement menstrual leave systems, this figure drops to 41% among small- and medium-sized enterprises (10–99 employees). However, in practice, actual utilisation is low: only 0.9% of female employees took menstrual leave in 2020. ³⁶ Even though the percentage of workplaces in which female employees requested menstrual leave rose modestly from 2.2% in 2015 to 3.3% between April 2019 and March 2020, the uptake remained stagnant.^37,38 These figures suggest that despite legal availability, cultural and structural barriers in Japan continue to discourage its utilisation.

Internationally, few countries have institutionalised menstrual leave. Some, such as Indonesia, South Korea and Zambia,^39,40 offer formal policies – for instance, Indonesia grants 2 days of menstrual leave per month, ⁴¹ while South Korea permits 1 day per month. However, even where policies exist, usage remains limited due to cultural stigma and lack of awareness. ⁴² Conversely, Spain became the first European country to officially introduce a menstrual leave policy in 2023. ⁴³ Most other high-income countries, including the United States, the United Kingdom, and Germany, lack national policies specifically addressing menstrual leave, instead relying on general sick leave provisions. These disparities highlight ongoing global inconsistencies in the recognition of menstrual health in labour legislation.

Moreover, structural workplace barriers, such as insufficient access to clean, private sanitation facilities, compounded participants’ menstrual health concerns. Many women reported anxiety about menstrual blood leakage due to restricted access to toilets, adding to their daily stress. In contrast, emerging best practices in countries such as New Zealand and Sweden include providing period-friendly workplace infrastructure such as rest areas and free sanitary products.^44,45 These findings highlight the critical need for improved workplace infrastructure—including adequate sanitation facilities and more flexible, supportive leave policies – to better accommodate women's health needs.

Interestingly, the reluctance to speak openly about menstrual or hormonal health issues was not limited to male-dominated workplaces. Even participants working in female-majority environments reported internalised stigma and hesitation. This indicates that cultural norms, workplace dynamics, and the absence of structured support mechanisms may perpetuate silence around women's health, irrespective of the gender composition of the workplace setting.

Potential of FemTech and digital health tools

FemTech, a term coined by Ida Tin in 2013, represents technology-driven solutions addressing women's health needs. ²⁰ Globally, both the FemCare and FemTech markets are expanding, with Japan's market valued at approximately 75 and 80 billion yen, respectively, in 2023.^46,47 However, issues related to women's health – including menstruation, infertility treatment and menopause—remain underexplored in Japan, and many women lack adequate knowledge in these areas.^19,48 Despite the availability of innovative solutions, FemTech adoption in Japan remains limited, particularly among women employed in small organisations or sectors such as education and healthcare.

Women in their 30s and 40s expressed particular interest in apps focused on sustained health improvement and beauty management. This suggests potential for market growth, with increased demand for app development anticipated in the future. Participants also expressed a strong need for user-friendly, personalised and affordable digital health tools. Although menstrual health was most frequently discussed, some participants also voiced expectations related to fertility support, pregnancy monitoring and managing perimenopausal symptoms such as hot flashes, mood changes or sleep difficulties. These life-stage milestones, while less commonly mentioned, highlighted the need for FemTech solutions that address not only menstruation but also the broader continuum of reproductive health. Notably, FemTech tools that support fertility tracking, conception timing and early pregnancy monitoring – as well as features tailored to perimenopausal changes such as mood tracking, sleep quality assessment and hormone-related symptom logging – could play a critical role in closing these care gaps. Addressing these life-stage-specific needs through digital health solutions would allow more comprehensive support of working women across the reproductive continuum. Essential features identified included symptom tracking, tailored feedback and customisable settings to enhance sustained engagement. However, participants highlighted several barriers to adoption, such as concerns over data security – particularly the risk of sensitive information related to menstrual health, fertility treatments and menopausal symptoms being disclosed within the workplace – difficulties integrating these tools into daily routines, and scepticism about app reliability.

To further support the thematic analysis, a heatmap was introduced to visualise the frequency of participants’ expectations across different age groups. This provided a clear representation of generational trends, revealing that participants in their 30s and 40s reported higher expectations for functions such as beauty management, symptom tracking and physical condition monitoring. The heatmap served as a concise and effective method to illustrate qualitative trends and highlight evolving user needs across life stages.

Notably, participants aged 50 and older expressed fewer opinions regarding expectations for new IoT devices or app development, highlighting generational disparities in digital literacy. In Japan, smartphone and tablet usage among individuals aged 18 to 29 years is nearly universal, approaching 100%. However, usage declines with age, with only 84.3% of those aged 50 to 59 using such devices. ⁴⁹ This digital divide mirrors trends across other high-income countries, where the OECD reports lower digital proficiency and access among older adults. ⁵⁰ In practice, lower digital literacy impeded adoption owing to onboarding challenges (e.g. account creation and multi-step authentication), navigation difficulties (e.g. small text and icons, dense menus) and uncertainty regarding data security and potential employer access. Consequently, despite the increasing availability of apps and devices supporting women's health, these tools may remain underutilised among certain demographic groups. Therefore, facilitating their adoption and ensuring effective utilisation remain critical challenges moving forward.

These findings emphasise the importance of evidence-based, user-centred design, targeted digital literacy support for older workers, and workplace integration strategies to improve the accessibility and impact of FemTech solutions. Practical measures include brief workplace-based onboarding sessions at induction or shift changes, peer support, just-in-time micro-tutorials, and access to a help line or chat. From a design perspective, simplified step-by-step workflows with progressive disclosure, larger typography and tap targets, plain-language instructions, low-friction log-ins (e.g. single sign-on or biometrics), optional voice input, offline functionality, and transparent privacy dashboards are likely to reduce usability barriers and increase confidence among older users. Equitable access to digital health tools has the potential to significantly benefit working women across diverse sectors by addressing their specific, life-stage-dependent health needs.

Ethical and policy considerations

Ethical concerns regarding privacy and data security emerged as central issues in this study. Participants expressed fears about the potential misuse of sensitive health information, such as fertility-tracking records, by employers or insurers. Data security is a critical aspect of digital health technology, ⁵¹ and addressing these concerns is essential to building trust and promoting adoption.

Globally, frameworks such as WHO guidelines and regulations in countries such as Germany and Canada prioritise data security and user privacy.^52–54 For example, the European General Data Protection Regulation mandates strict consent protocols and upholds user rights regarding digital health data. ⁵⁵ Similarly, in the United States, the Health Insurance Portability and Accountability Act ensures the confidentiality and security of health information. ⁵⁶ However, Japan currently lacks standardised criteria for evaluating digital health tools, highlighting an urgent need for national guidelines.

Policy interventions are also needed to ensure equitable access to FemTech. Subsidising FemTech products and integrating them into workplace health programmes could improve accessibility, while incentives such as health insurance discounts may further encourage adoption. However, fostering supportive workplace environments is equally important. Raising awareness among both employers and employees about the benefits of FemTech, and establishing inclusive, gender-sensitive policies will be key to facilitating widespread adoption. In light of the privacy concerns raised by participants, it is particularly important for the Japanese government to develop standardised evaluation criteria for digital health tools, including clear data protection standards and user transparency requirements.

Future directions for digital health development for working women

Participants highlighted the need for digital health tools that balance simplicity with robust functionality. Desired features included personalised feedback, seamless integration into daily routines, and secure handling of sensitive data. Addressing barriers such as complex data entry processes, concerns over technology dependence, and fears of workplace repercussions is critical.

At the organisational level, employers have a range of options to integrate FemTech into workplace health programmes. These include incorporating evidence-based tools into occupational health or employee assistance schemes, offering opt-in access to vetted apps or services subsidised by the employer, providing onboarding sessions at induction or shift handovers, and equipping managers with guidance materials. For example, Vodafone has developed a publicly available Menopause Toolkit that includes policy templates, manager training materials, and employee resources, while channel 4 introduced a formal menopause workplace policy in the UK context.^57,58 At the product and design level, simplified user interfaces, larger text and tap targets, progressive disclosure of features, offline functionality, and transparent privacy settings can improve usability and adoption – particularly among older users and those with lower digital literacy. At the policy level, national guidelines for the evaluation of non-medical digital health tools, including minimum standards for data protection, user transparency and interface design, would support procurement, comparability and user confidence. These initiatives have the potential to position FemTech as a transformative tool for improving women's health and well-being.

As the global digital health market continues to grow, Japan should establish standardised frameworks to evaluate the quality, safety and reliability of digital health tools. Such measures are likely to foster user trust and encourage broader adoption. Additionally, expanding access to these technologies across diverse sectors, including local governments, small businesses and public institutions, is essential to ensure that all working women benefit equitably. Combined with workplace reforms and national policy guidelines, these efforts could position FemTech as a transformative tool for improving women's health and well-being. In particular, the post-COVID-19 era – with its acceleration of digital transformation and hybrid work environments – underscores the growing importance of flexible, accessible and personalised health support systems for working women. To enhance adoption and sustained engagement, it is important to ensure that future solutions are closely aligned with the barriers and needs identified in this study. These include workplace culture, privacy concerns, and usability challenges, as well as participant expectations for simplicity, integration into daily routines, and support at the organisational level. Addressing these areas will be key to developing meaningful and effective digital health tools.

Limitations

Although the present study reveals important findings, several limitations should be acknowledged. The sample size was relatively small and not geographically representative of Japan as a whole. Consequently, the findings may have limited generalisability, given the purposive selection of participants. Moreover, the use of kinship-based recruitment may have resulted in the inclusion of individuals with closer social or professional ties to the researchers, which may have increased rapport and willingness to disclose sensitive information while also introducing selection effects due to network homophily. To minimise bias, recruitment procedures excluded individuals with prior supervisory or reporting relationships, and study materials highlighted the voluntary nature of participation and assured confidentiality. Furthermore, purposive maximum-variation sampling was employed to target heterogeneity across age, occupational domain and work environment. Nonetheless, residual selection bias cannot be excluded. Additionally, the use of a web-based research panel may have overrepresented women with higher digital literacy or a pre-existing interest in health technology, such as FemTech or wearable devices. This selection bias may limit the applicability of the findings to women who are less engaged with or have limited access to digital health tools. Furthermore, although the sample included women from a variety of physically and mentally demanding occupations, it may not fully represent the experiences of those in sectors not covered in this study, such as agriculture, informal caregiving or certain service industries. Women with very low digital literacy or limited access to technology may also have been underrepresented, particularly if they declined to participate due to discomfort surrounding or unfamiliarity with digital platforms. Analytic saturation was reached after n = 17 one-on-one interviews, defined operationally as the point at which no new codes or themes emerged across consecutive interviews. However, exclusive reliance on one-on-one interviews may not capture interactional dynamics that could emerge in focus groups. Accordingly, the findings should be regarded as transferable insights into cross-cutting themes rather than statistically generalisable estimates for specific occupational subgroups.

Future research should address these limitations by involving a larger, more demographically and occupationally diverse population and incorporating perspectives from different cultural and professional contexts. Despite these limitations, this study offers valuable and timely insights into the development of digital health tools to support the health and well-being of women working in high-stress environments.

Conclusion

This study highlights the need to integrate digital health technologies into broader efforts to support the health and well-being of working women, particularly those employed in smaller organisations and high-stress occupational settings where adoption of these technologies remains limited. Multi-level strategies addressing individual, organisational, and policy-related challenges are essential, with an emphasis on inclusivity for diverse demographics and individuals with limited digital literacy.

At the organisational level, employers can support adoption by integrating vetted FemTech tools into occupational health programmes, offering opt-in access, onboarding support during induction or shift transitions, and manager training to foster psychologically safe environments. At the product level, simplified interfaces and transparent privacy settings can improve usability, particularly for older users or those with lower levels of digital confidence. At the policy level, national evaluation frameworks are needed to establish minimum standards for safety, privacy, and usability. By aligning these efforts with users’ needs – such as daily routine integration, data security and life-stage relevance – FemTech and digital health technologies can be more strategically deployed to deliver sustained value in women's working lives.

Collaboration among policymakers, developers and employers is crucial to ensuring that these tools are accessible, reliable and tailored to the diverse needs of users.

Supplemental Material

sj-docx-1-dhj-10.1177_20552076251379747 - Supplemental material for Working women's perceptions and expectations of digital health tools for personal health management: A qualitative study

Supplemental material, sj-docx-1-dhj-10.1177_20552076251379747 for Working women's perceptions and expectations of digital health tools for personal health management: A qualitative study by Kiriko Sasayama, Tomoko Saso, Yuko Egawa, Etsuko Nishimura, Erika Ota, Hisateru Tachimori, Ataru Igarashi, Naoko Arata, Daisuke Yoneoka and Eiko Saito in DIGITAL HEALTH

Supplemental Material

sj-docx-2-dhj-10.1177_20552076251379747 - Supplemental material for Working women's perceptions and expectations of digital health tools for personal health management: A qualitative study

Supplemental material, sj-docx-2-dhj-10.1177_20552076251379747 for Working women's perceptions and expectations of digital health tools for personal health management: A qualitative study by Kiriko Sasayama, Tomoko Saso, Yuko Egawa, Etsuko Nishimura, Erika Ota, Hisateru Tachimori, Ataru Igarashi, Naoko Arata, Daisuke Yoneoka and Eiko Saito in DIGITAL HEALTH

Supplemental Material

sj-docx-3-dhj-10.1177_20552076251379747 - Supplemental material for Working women's perceptions and expectations of digital health tools for personal health management: A qualitative study

Supplemental material, sj-docx-3-dhj-10.1177_20552076251379747 for Working women's perceptions and expectations of digital health tools for personal health management: A qualitative study by Kiriko Sasayama, Tomoko Saso, Yuko Egawa, Etsuko Nishimura, Erika Ota, Hisateru Tachimori, Ataru Igarashi, Naoko Arata, Daisuke Yoneoka and Eiko Saito in DIGITAL HEALTH