User-centered design of a rule-based expert system for autonomous menstrual management: an expert-validated voice assistant for women with visual impairments

OBJECTIVE: Most women with visual impairments rely on others, particularly their mothers, in managing menstruation. They also face unique challenges that are more complex than those experienced by other members of society. This highlights a privacy gap in menstrual health management among women with visual impairments. This study aims to design and evaluate a voice-based assistive technology that integrates voice-based interaction and a decision tree approach to support autonomous menstrual management and reproductive hygiene among women with visual impairments. METHODS: This study adopted a user-centered design (UCD) approach involving need assessment, expert validation, and usability testing. A rule-based branching algorithm derived from clinical decision trees was implemented and evaluated through heuristic-based usability testing with target users. IMPACT: The evaluation results showed that the voice-based application was well-accepted by women with visual impairments. Participants expressed positive perceptions of speech recognition, navigation, menstrual data management, accessibility and user experience. The integration of voice-based interaction and expert-validated decision logic was perceived as a reliable tool for menstrual status verification and hygiene management. The application significantly enhanced perceived autonomy, privacy, and confidence in self-menstrual management. This study demonstrates the feasibility of voice-based interaction with simplified rule-based branching logic to support independent menstrual detection and hygiene management among visually impaired women. The integration of expert-validated decision support and accessible voice interaction enables the application to address essential gaps in privacy and independence in menstrual hygiene management. These findings indicate the potential of clinically informed, user-centered assistive technologies to improve reproductive health self-management among individuals with visual impairments.