Inclusive Sex and Gender Data Collection in Survey Research The Health Researcher’s Toolkit: Why Sex and Gender Matter

  • Introduction
    • The Health Researcher’s Toolkit: Why Sex & Gender Matter
    • Introduction
    • Module Objectives
    • Presenter Profile
  • Content
    • Sex & Gender
    • Module Introduction
    • Key Terms & Concepts
    • Dr. Greta Bauer Part 1: Lecture Video
    • Dr. Greta Bauer Part I: Dimensions of Sex and Gender
    • Dr. Greta Bauer Part I: Gender Inclusive Data
    • Dr. Greta Bauer Part I: Two Step Questions
    • Knowledge Check-in
    • Dr. Greta Bauer Part II: Lecture Video
    • Dr. Greta Bauer Part II: Cisnormativity
    • Lecture Summary: Dr. Greta Bauer Part II: Skip Patterns
    • Lecture Summary: Dr. Greta Bauer Part II: Sex and Gender Inclusivity
    • Module Summary
  • Conclusion
    • Module Quiz
    • Quiz Results
    • Reflection
    • Resources
    • About Women's Xchange
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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

Inclusive Sex and Gender Quantitative Data Collection

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

Presenter: Dr. Greta Bauer

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Module Objectives

In this module, you will learn

  • Why data measures need to be inclusive of sex and gender diversity
  • How to recognize when poor data measures are affecting research
  • How to design effective data measures that incorporate sex and gender dimensions
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Presenter Profile

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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Sex & Gender

Not interchangeable terms

Sex

  • Biological attributes
  • Associated with physical and physiological features
  • Often conceptualized as binary: female or male
    • However biological attributes and expression can vary 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

Gender

  • Socially constructed and fluid
  • Culturally specific
  • Roles, behaviours, expressions, identities of girls, women, boys, men, gender diverse people
  • Gender identity
    • One’s innermost concept of self
    • May be same or differ from sex assigned at birth
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Module Introduction

Understand sex and gender to:

  • Achieve more robust research findings
  • Identify inequities in health care

Dr. Bauer’s focus

  • Large population surveys but applicable to other contexts

Strategies for

  • Asking participants about their sex and/or gender
  • Determining which dimensions are relevant to your research
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Key Terms & Concepts

Transgender or trans: Identifying as a gender other than what a person was assigned at birth

Transmasculine: A person assigned female at birth and now identifying as a man, or a gender identity other than a woman

Transfeminine: A person assigned male at birth and now identifying as a woman, or a gender identity other than a man

Non-Binary: A person who does not identify exclusively as a man or woman

Cisgender or cis: Identifying as the gender assigned at birth

Cisnormativity: The assumption that all domains of sex and gender are consistent within individuals and stable across the life course

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Dr. Greta Bauer Part 1: Lecture Video

The words people use to describe their gender

  • Vary from person to person
  • Change over time
  • Are culturally specific
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Dr. Greta Bauer Part I: Dimensions of Sex and Gender

Ask: Which dimensions of sex and gender are important to my research question?

Sex:

  • Chromosomal sex
  • Sex assigned at birth
  • Hormonal milieu
  • Genital and reproductive organs
  • Secondary sex characteristics

Gender:

  • Gender identity/felt gender
  • Lived gender
  • Conventional masculinity/femininity
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Dr. Greta Bauer Part I: Gender Inclusive Data

  • Gender inclusive data collection is more than adding checkbox for “other”;
    • Excludes people who don’t fit cisnormative perceptions of gender and sex
  • “Other” field responses will also be difficult to quantify
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Dr. Greta Bauer Part I: Two Step Questions

Sex and gender analysis in Canada

  • Ask a 2-step question or series of questions
    • Sex assigned at birth
    • Current gender identity
  • Be inclusive of Indigenous, other cultural or non-binary identities
  • Simple, specific language
  • Use examples
  • Consider questions about hormones, surgeries if relevant
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Knowledge Check-in

A researcher is preparing to conduct a study on prostate cancer risk. Who should be included in the study population?

Which of the following provides the most relevant information on sex/gender in health research studies?

You are designing a population study and would like to collect information that would identify trans participants. What is the best way to gather this data?

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Dr. Greta Bauer Part II: Lecture Video

Cisnormativity

  • Assumptions about gender and sex
  • Can impact validity of health research
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Dr. Greta Bauer Part II: Cisnormativity

Cisnormativity

  • Assumption that sex and gender are consistent
    • Within individuals
    • Across the life course
  • Assumptions can be false

Ask specific questions about dimensions of sex and gender that can be measured

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Lecture Summary: Dr. Greta Bauer Part II: Skip Patterns

Watch for skip patterns in surveys

  • Caused by assumptions about:
    • anatomy/physiology
    • gender of sex partners/relationships
    • consistency of sex and/or gender across the life course
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        Lecture Summary: Dr. Greta Bauer Part II: Sex and Gender Inclusivity

        Questions to ask

        • Are there sex and/or gender groups you want to compare?
        • What dimensions identify each group?
        • What dimensions may be causally important?
        • Is a sex and/or gender dimension being used as a proxy measure?
        • Have you accounted for sex and gender diversity in all measures?
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        Module Summary

        Data measures need to be inclusive of sex and gender diversity

        • To identify issues of inequity
        • To deliver more robust findings

        Recognize when poor quantitative data measures are affecting research

        • Patterns in the data indicate assumptions were made

        Design effective data measures

        • If groups are compared, what are the sex and gender dimensions?
        • Is a sex and/or gender dimension being used as a proxy measure?
        • Use a two-step question to explore sex and gender
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        Module Quiz

        Test Your Understanding

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

        1. Being inclusive of sex and gender diversity in health research methods provides which of the following benefits:

        2. True or False: The best way to improve a sex/gender question with only male and female options is to leave an open text box for participants to fill in.

        3. Why is it important for data collection to be sex and/or gender inclusive in the area of health research?

        4. Which of the following dimensions of sex or gender cannot change over an individual’s life course?

        5. True or False: Cisnomativity is defined as the assumption that all domains of sex and gender are consistent within individuals and stable across the life course.

        Quiz Results

        You got out of questions correct.



        1. Being inclusive of sex and gender diversity in health research methods provides which of the following benefits:

        Reflects respect for equity with regard to participation and representation

        Allows for identification of health inequalities

        Improves data quality and allows for more detailed analyses

        All of the above

        2. True or False: The best way to improve a sex/gender question with only male and female options is to leave an open text box for participants to fill in.

        True

        False

        3. Why is it important for data collection to be sex and/or gender inclusive in the area of health research?

        Sex and gender inclusivity improves the quality of the data

        It forces the researcher(s) to ask more specific questions

        Sex and gender inclusivity in data collection can help researchers identify health inequities

        All of the above

        4. Which of the following dimensions of sex or gender cannot change over an individual’s life course?

        Hormonal milieu

        Sexual or reproductive anatomy

        Sex assigned at birth

        Gender identity

        5. True or False: Cisnomativity is defined as the assumption that all domains of sex and gender are consistent within individuals and stable across the life course.

        True

        False

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        Reflection

        Consider assumptions made about dimensions associated with sex and gender

        • Effect on
          • measures
          • findings
          • analysis

        What could have been done differently?

        Resources

        For Additional Resources On These Topics:

        Eliason, M. J., & Chinn, P. L. (2017). LGBTQ cultures: What health care professionals need to know about sexual and gender diversity: Lippincott Williams & Wilkins.

        Bauer, G. R. (2014). Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Social Science & Medicine, 110, 10-17.

        Bauer, G. (2012). Making Sure Everyone Counts: Considerations for Inclusion, Identification and Analysis of Transgender and Transsexual Participants in Health Surveys/Pour s’ assurer que tout le monde compte: facteurs pouvant justifier l’inclusion, l’identification et l’analyse de participants transgenres et transsexuels dans les enquêtes sur la santé. CIHR Casebook: What a Difference Sex and Gender can make 59-68.

        Bauer, G. R., Hammond, R., Travers, R., Kaay, M., Hohenadel, K. M., & Boyce, M. (2009). “I don't think this is theoretical; this is our lives”: how erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care, 20(5), 348-361.

        Bauer, G. R., Braimoh, J., Scheim, A. I., & Dharma, C. (2017). Transgender-inclusive measures of sex/gender for population surveys: Mixed-methods evaluation and recommendations. PloS one, 12(5), e0178043.

        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.

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