Improving Health Knowledge and Services: Why Sex and Gender Matter The Health Researcher’s Toolkit: Why Sex and Gender Matter

  • Introduction
    • The Health Researcher’s Toolkit: Why Sex & Gender Matter
    • Introduction
    • Module Objectives
    • Presenter Profiles
  • Content
    • Getting Started
    • Dr. Sharon-Lise Normand: Lecture Video
    • Food for Thought I
    • Food for Thought II
    • Dr. Paula Rochon Part I: Lecture Video
    • Key Terms & Concepts: Sex
    • Key Terms & Concepts: Gender
    • Knowledge Check-in
    • Dr. Paula Rochon Part II: Lecture Video
    • Dr. Paula Rochon Part II: Sex Shapes Health
    • Dr. Paula Rochon Part II: Gender Shapes Health
    • Dr. Paula Rochon Part II: The Research Process
    • An Example: Sex and Gender Ambiguity
    • Dr. Greta Bauer: Sex and Gender Ambiguity
    • Content Review
    • Module Summary
  • Conclusion
    • Module Quiz
    • Quiz Results
    • Reflection
  • Case Study: Introduction
    • Case Study: Sex and Gender Disparities in Access to Care and Health Outcomes
    • Presenter Profile
  • Case Study: Content
    • Case Study Introduction
    • Key Terms & Concepts
    • Dr. Gillian Hawker Part I: Lecture Video
    • Dr. Gillian Hawker Part I: Administrative Data Interpretations
    • Dr. Gillian Hawker Part I: Treatment
    • Knowledge Check-in
    • Dr. Gillian Hawker Part II: Lecture Video
    • Dr. Gillian Hawker Part II: Patient Trends
    • Dr. Gillian Hawker Part II: Physician Trends
    • Case Study Summary I
    • Case Study Summary II
  • Case Study: Conclusion
    • Module Quiz
    • Quiz Results
    • Case Study Reflection
    • Case Study: Resources
    • About Women's Xchange

The Health Researcher’s Toolkit: Why Sex & Gender Matter

Developed by the Women’s Xchange

Learning objectives

  • Define sex and gender and know how to correctly apply these terms
  • Explain why sex and gender matter in health research
  • Identify and apply methods for integrating sex and gender in different types of studies
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Introduction

Improving Health Knowledge and Services Through the Application of A Sex and Gender Lens.

A module of The Health Researcher’s Toolkit: Why Sex and Gender Matter

Main Presenter: Dr. Paula Rochon

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Module Objectives

In this module, you will learn

  • Why sex and gender matter in health research
  • The definitions of sex and gender
  • How to correctly apply these terms


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Presenter Profiles

Dr. Paula Rochon

Lead, Women’s Xchange

Vice-President, Research, Women’s College Hospital

Professor, Department of Medicine and Institute of Health Policy, Management & Evaluation, University of Toronto

Download Dr. Rochon’s biography




Dr. Sharon-Lise Normand
Professor
Health Care Policy (Biostatistics)
Harvard Medical School
Department of Biostatistics
Harvard School of Public Health

Download Dr. Normand’s biography



Dr. Greta Bauer
Associate Professor
Department of Epidemiology & Biostatistics
Schulich School of Medicine & Dentistry
Western University

Download Dr. Bauer’s biography



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Getting Started

Why do sex and gender matter to health research?

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Dr. Sharon-Lise Normand: Lecture Video


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Food for Thought I

What is the cost of not recognizing depression in men?

  • Longer suffering for individuals
  • Decline in their overall health
  • Negative impact on relationships and employment
  • Interventions more intensive
  • More expensive to health system
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Food for Thought II

Do women and men experience depression differently?

  • If there are differences, are there biological or physiological causes?
  • Are there other causes for differences in symptoms?
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Dr. Paula Rochon Part I: Lecture Video

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Key Terms & Concepts: Sex

Sex

  • Biological attributes
  • Associated with physical and physiological features
  • Often conceptualized as binary: female or male
  • Yet there is variation in biological attributes as individuals may be born with reproductive anatomy that doesn’t fit the typical definition of female or male
  • Commonly understood as what was assigned at birth
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Key Terms & Concepts: Gender

Gender is

  • Socially constructed and fluid
  • Roles, behaviours, expressions, identities of girls, women, boys, men, gender diverse persons
  • Gender identity is one’s innermost concept of self
    • May be same or differ from sex assigned at birth

Gender is not

  • The polite way to say sex
  • A term that can used interchangeably with the term sex

Knowledge Check-in


Identify the attribute that is not tied to a person’s sex.

Female physicians are more likely to provide positive talk, counselling and referrals to patients with symptoms of depression than male physicians. Is this statement about sex or gender?

M. wears lipstick and a skirt. She has a picture of her son and husband on her desk. What do we know about M. based on this brief description?

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Dr. Paula Rochon Part II: Lecture Video

Example: problems in drug therapy

  • Why gender and sex matter to health research
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Dr. Paula Rochon Part II: Sex Shapes Health

Sex is physiological and biological

An example: when a physiologically-specific population is not represented in a drug trial

  • Experience is unknown
  • Over-represented populations influence dosage
    • Dosage may not be appropriate for other groups

Sex influences health

  • Quality of intervention
  • Risk for harm
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Dr. Paula Rochon Part II: Gender Shapes Health

Gender shapes health

  • Behaviours by patients
  • Assumptions by physicians
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Dr. Paula Rochon Part II: The Research Process

Think about sex and gender throughout the research process


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An Example: Sex and Gender Ambiguity

When sex and/or gender are not clear

Note:

  • Impact on findings
  • What was missed
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Dr. Greta Bauer: Sex and Gender Ambiguity

Cisnormativity

  • Assumption that all domains of sex and gender are
    • Consistent within individuals
    • Stable across the life course
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Content Review

Conflating sex and gender will negatively impact research

  • Assumption: woman = uterus
    • Resulted in inclusion of women who did not have uteruses
  • Corrected: changed knowledge about
    • Prevalence
    • Age-distribution
    • Racial disparities
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Module Summary

Sex and gender affect health

  • Both influence quality of the health intervention and risk for harm
  • Exclusion or misclassifications result in
    • Health inequities
    • Inaccurate findings
  • Must be considered throughout the research process
  • Ignoring or conflating: costly
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Module Quiz

Test Your Understanding

  • Five questions
  • Select the best response
  • When you answer all, click submit

1. Which of the following statements is NOT about gender?

2. In which of the following is the sex of the patient more relevant than their gender?

3. You want to conduct a study on depression and have a number of research questions. Which of the following questions focuses on the sex of the participants, rather than their gender?

4. You are designing a research study on prostate cancer. Which of the following categories will you select for your research participants?

5. You are reporting on a study that drew the demographic data for the participants from their birth certificates. What can you report about the participants’ sex and/or gender?

Quiz Results

You got out of questions correct.



1. Which of the following statements is NOT about gender?

For most girls, menstruation begins around age 12

Young men are more likely to be incarcerated than females of the same age

Women make up more than half of medical students in Canada

On average men have a higher income than women

2. In which of the following is the sex of the patient more relevant than their gender?

Frequency of visits to a health care provider

Description of symptoms

Drug dosage

The sex of the patient relevant in all these situations

3. You want to conduct a study on depression and have a number of research questions. Which of the following questions focuses on the sex of the participants, rather than their gender?

What are people’s perception of men’s symptoms of depression?

Do physicians fail to diagnose men?

Do men have physiological symptoms associated with depression that differ from those of women?

All of these questions are about gender

4. You are designing a research study on prostate cancer. Which of the following categories will you select for your research participants?

Participants who are male

Participants who were assigned male at birth

Participants who identify as men

Participants who have prostates

5. You are reporting on a study that drew the demographic data for the participants from their birth certificates. What can you report about the participants’ sex and/or gender?

A. Sex assigned at birth

B. Sex and gender based on whether the participant is male or female

C. Gender based on first name

A and C

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Reflection

Examples in which sex and gender were used interchangeably?

Health care situations in which blurring sex and gender had/could have serious implications?

In your research: how can you more clearly define, identify and report on sex and gender?

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Case Study: Sex and Gender Disparities in Access to Care and Health Outcomes

In this case study, you will learn

  • About the some of the challenges associated with administrative data
  • How gender similarities in one measure may hide underlying differences
  • How physician bias can impact access to care
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Presenter Profile

Dr. Gillian Hawker
Sir John & Lady Eaton Professor of Medicine and Chair
Department of Medicine, University of Toronto

Download Dr. Hawker’s biography

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Case Study Introduction

Patient outcomes are influenced by gender differences in

  • patient willingness
  • access to an intervention
  • physician-patient interactions
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Key Terms & Concepts

Administrative data: Data collected for administrative reasons, which may be leveraged for other purposes (Cadarette and Wong, 2015)

Osteoarthritis or OA: a disease of the whole joint that leads to breakdown of joint cartilage and the underlying bone

Total Joint Arthroplasty or TJA: Highly effective treatment for osteoarthritis when non-surgical therapies have failed

Unmet need: Exists when there is both patient need and willingness to receive a specific health care service, but the patient does not receive the health care service.

Unconscious bias: Also known as implicit bias, this refers to social stereotypes formed outside of an individual’s own conscious awareness. Unconscious bias can be incongruent with the individual’s own conscious values.

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Dr. Gillian Hawker Part I: Lecture Video

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Dr. Gillian Hawker Part I: Administrative Data Interpretations

Interpretations of administrative data

  • Assume equal access

Women have

  • Greater need for surgery
  • Greater unmet need (suitability and willingness)

Women less likely to be offered the health care option

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Dr. Gillian Hawker Part I: Treatment

The strongest predictor of accessing care: willingness to undergo treatment

Sex and/or gender not found to be a predictor of willingness

  • Both men and women more likely to be willing if family or friends recommended
  • However, many other factors influencing willingness were determined by sex and gender;
    • Influencing factors reflected typical roles, behaviours and expressions associated with men and women
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Knowledge Check-in

Which patient has an unmet need?

What was the underlying assumption in the interpretation of administrative data on joint replacement surgery?

True or False: Administrative data allows researchers to analyze sex differences, but not gender differences.

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Dr. Gillian Hawker Part II: Lecture Video

The impact of sex and gender on access to care

  • Physician/patient interaction
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Dr. Gillian Hawker Part II: Patient Trends

Male "patients"

  • Less conversational with physicians
  • Less likely to talk about risks


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Dr. Gillian Hawker Part II: Physician Trends

Physicians were more likely to

  • Offer the health care intervention to men
  • Provide more information to men
  • Ask men about their preferences

Trends more extreme with surgeons than family physicians

  • Did not vary with the sex of the doctor

(Borkhoff, 2015)

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Case Study Summary I

Administrative health data

  • Only provides information about who received care

Unmet need

  • There is patient need and willingness but service is not offered/provided
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Case Study Summary II

Sex and gender-influences can impact need and preferences for health care services

  • Female sex more susceptible to osteoarthritis
  • Men and women both less likely to get surgery if unwilling;
  • But unwilling for reasons related to gender

Sex and gender factors also affect affect physician/patient interactions

  • Physicians, regardless of their sex, less likely to direct women to joint replacement, provide information, ask preference;
  • Conscious and unconscious biases
  • Women more conversational and more likely to ask about risks than men

Module Quiz

Test Your Understanding

  • Four questions
  • Select the best response
  • When you answer all, click submit

1. In the study on physician’s interactions with their patients, which sex and gender difference was NOT observed?

2. Although women are more likely to see their doctors for osteoarthritic pain, women are less likely to be referred for joint replacement surgery. This may be due to:

3. True or False: You cannot study disparities in health care using administrative data.

4. The research presented in this module demonstrates that sex and gender can impact an individual’s

Quiz Results

You got out of questions correct.



1. In the study on physician’s interactions with their patients, which sex and gender difference was NOT observed?

Female physicians were more likely than male physicians to suggest the intervention to their patients.

Male patients were less likely to ask physicians about risks of the surgery.

Female patients were less likely to be offered the surgery by physicians.

Male patients were asked their preference more often than female patients.

2. Although women are more likely to see their doctors for osteoarthritic pain, women are less likely to be referred for joint replacement surgery. This may be due to:

Physicians attributing women’s complaints to emotional issues

Women ask more questions about risk than men

Unconscious bias about outcomes after surgery

All of the above

3. True or False: You cannot study disparities in health care using administrative data.

True

False

4. The research presented in this module demonstrates that sex and gender can impact an individual’s

Access to health care information

Access to health care options

Willingness to access a medical intervention

All of the above

Case Study Reflection

Can you think of other examples where health care access disparities may be missed because of reliance on administrative data? How could these be studied?

Are there measures that might be related to sex or to gender in the data you use? How might incorporating these measures help you think about and understand why differences between men and women might be present?

Case Study: Resources

Additional Resources:

European Institute for Gender Equality - Gender Equality in Academia and Research Toolkit

National Democratic Institute - Gender Primer Exercise

Status of Women Canada, GBA+ Course: Module 1: Sex and Gender - A Place to Begin

Borkhoff, C.M., Hawker, G.A., Wright, J.G., “Patient gender affects the referral and recommendation for total joint arthroplasty”, Clinical Orthopeadics and Related Research, 2011 Jul; 469(7).

Cadarette, S.M., and Wong, L., “An Introduction to Health Care Administrative Data”, The Canadian Journal of Hospital Pharmacy, 2015 May-Jun; 68(3).




About Women's Xchange

Based at Women’s College Hospital, Women’s Xchange is a women’s health knowledge translation and exchange centre, designed to promote women’s health research across the province. Funded by the Ministry of Health and Long-Term Care’s Health Service Research Fund (HSRF), the centre supports women’s health research in both academic and community settings. In addition to supporting research, Women’s Xchange also provides women’s health researchers and trainees across the province with opportunities to gain new skills and develop new collaborations.

The Health Researcher’s Toolkit: Why Sex and Gender Matter

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