Integrated Mixed Methods: LGBTQ2S Home Care Access 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. Andrea Daly Part I: Lecture Video
    • Dr. Andrea Daly Part I: Qualitative and Quantitative Approach
    • Dr. Andrea Daly Part I: Intersectional Approach
    • Dr. Andrea Daly Part I: Marginalized Communities
    • Knowledge Check-in
    • Dr. Andrea Daly Part II: Lecture Video
    • Dr. Andrea Daly Part II: Intergenerational Approach
    • Dr. Andrea Daly Part II: Design Stage
    • Dr. Andrea Daly Part II: Method Stage
    • Dr. Andrea Daly Part II: Reporting Stage
    • Module Summary I
    • Module Summary II
  • Conclusion
    • Module Quiz
    • Quiz Results
    • Reflection
    • About Women's Xchange
  • Case Study: Introduction
    • Case Study: Surveying Challenges with LGBTQ2S Homeless Youth
    • Presenter Profile
  • Case Study: Content
    • Case Study: Key Terms & Concepts
    • Dr. Alex Abramovich Part I: Lecture Video
    • Dr. Alex Abramovich Part I: Transgender & Cisgender
    • Dr. Alex Abramovich Part I: Trans Youth
    • Knowledge Check-in
    • Dr. Alex Abramovich Part II: Lecture Video
    • Dr. Alex Abramovich Part II: Institutional Erasure
    • Dr. Alex Abramovich Part II: Discrimination and Health
  • Case Study: Conclusion
    • Case Study Summary I
    • Case Study: Summary II
    • Case Study Summary III
    • 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

Toolkit 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

Integrated Mixed Methods: LGBTQ2S Home Care Access

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

Presenter: Dr. Andrea Daley

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Module Objectives

In this module, you will learn

  • Why an integrated mixed methods approach is effective for exploring equity issues in healthcare
  • How the integrated mixed method approach was used in this study of the LGBTQ2S population’s access to home care
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Presenter Profile

Dr. Andrea Daley
Associate Professor
School of Social Work
York University

Download Dr. Daley’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

Integrated mixed method approach with sequential explanation design

  • Inequities in home care provision for LGBTQ2S communities in Ontario
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Key Terms & Concepts

LGBTQ2S: The acronym used in The Health Researcher’s Toolkit for people who identify as lesbian, gay, bi-sexual, trans, queer or two-spirited. Presenters in the Toolkit might use variations of this acronym or “queer communities”.

Sexual Orientation: A person’s tendency to be romantically and/or sexually attracted to a sex and/or gender. Sex, gender and sexual orientation intersect and one does not assume another.

Equity: The absence of systematic disparities in health between groups with different levels of underlying social advantage. Inequities in health put already socially disadvantaged groups at further disadvantage with respect to their health. (Braveman & Gruskin, 2003)

Mixed Method: A distinct research methodology with the potential to produce transformative knowledge through the use of both quantitative and qualitative data. A mixed methods approach can provide enhanced understanding of equity and social justice issues. (Fetters, et al., 2013)

Integrational Approach: The intentional combination of quantitative and qualitative approaches throughout the study’s procedures, from design to data analysis and reporting. This combination can provide researchers with a better understanding of the participants’ lived experience. (Fetters, et al., 2013)

Sequential Explanation Design: A mixed method technique through which data from the quantitative phase of the study is used to inform qualitative data collection and analysis in subsequent phases. This allows more in-depth explanations of the study’s findings. (Fetters, et al., 2013)

Transformative Potential: The potential for research evidence to inspire change or shift thinking of health service providers, policy-makers and the general public. (Fetters, et al., 2013)

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Dr. Andrea Daly Part I: Lecture Video

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Dr. Andrea Daly Part I: Qualitative and Quantitative Approach

Mixed method combines qualitative with quantitative

Quantitative asks

  • “Who”
  • “What”
  • “Where”
  • “How”

Qualitative interviews ask

  • “Why”
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Dr. Andrea Daly Part I: Intersectional Approach

Intersectional approach

  • Beyond a single category of identity
  • Inter-relatedness of different aspects of identity

(Hankivsky & Cormier, 2009)

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Dr. Andrea Daly Part I: Marginalized Communities

When researching marginalized communities

  • Advisory committee of individuals from the community
    • Involve them at every level of the study
    • Contribute to design and interpretation
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Knowledge Check-in

Mixed methods research is a powerful tool for:

True or False: A mixed methods approach is a distinct third methodological movement with the ability to produce transformative knowledge through the intentional use of both survey data and narrative data.

A mixed methods approach integrates quantitative and qualitative data. Identify the qualitative question from the following:

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Dr. Andrea Daly Part II: Lecture Video

  • How mixed methods can be intentionally integrated
  • Achieving transformative outcomes
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Dr. Andrea Daly Part II: Intergenerational Approach

Intergenerational approach

  • Enhances the value of mixed methods research
  • Produces findings greater than the sum of the quantitative and qualitative findings
  • Can be implemented at any level or throughout
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Dr. Andrea Daly Part II: Design Stage

Integration at design stage

  • Explanatory sequential - quantitative data informs qualitative data collection and analysis
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Dr. Andrea Daly Part II: Method Stage

Method stage

  • Connecting - recruit qualitative participants from quantitative
    • Collates quantitative and qualitative data from the same sample
  • Build - quantitative data guided qualitative portion
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Dr. Andrea Daly Part II: Reporting Stage

Interpretation and reporting stage

  • Weaving - integrate qualitative and quantitative findings by theme
  • Contiguous - map qualitative findings onto external document
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Module Summary I

Integrated mixed methods approach is effective for exploring equity issues in healthcare through

  • Phenomenological experiences at intersections of identities
  • Complexities and nuances
  • Social constructs (e.g. gender) that shape individuals’ experiences

Can produce knowledge with transformative potential to improve equity in health policy and practice

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Module Summary II

Integrated mixed methods in this example

  • Qualitative findings informed quantitative methods
  • Narrative and statistics were interpreted and presented woven together
  • Engagement of LGBTQ2S community throughout
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Module Quiz

Test Your Understanding

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

1. Dr. Daley’s study is an example of mixed methods because

2. Intersectionality refers to

3. In mixed methods research, integration can be included at which level(s) of a study?

4. The integration of sex and gender in health research is key for understanding differences in health outcomes. Which research method best captures the lived experience of study participants?

5. True or False: Integrated mixed methods research can be used as a social justice tool and provide powerful evidence to inform policy and practice change.

Quiz Results

You got out of questions correct.



1. Dr. Daley’s study is an example of mixed methods because

A. Early stages of the study informed later stages

B. It included surveys and interviews

C. It included service users and service providers

D. A and B

2. Intersectionality refers to

The inter-relatedness of different aspects of identity

Linking methods of data collection and analysis to produce findings that are greater than the sum of the parts

Combining input from different stakeholders

Interpreting and reporting qualitative and quantitative findings together

3. In mixed methods research, integration can be included at which level(s) of a study?

Design

Reporting

C. Interpretation and reporting

All of the above

4. The integration of sex and gender in health research is key for understanding differences in health outcomes. Which research method best captures the lived experience of study participants?

Randomized-control trial

Qualitative study

Observational study

Demographic study

5. True or False: Integrated mixed methods research can be used as a social justice tool and provide powerful evidence to inform policy and practice change.

True

False

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Reflection

What are health equity issues in your research area?

How could an integrated mixed methods approach unearth the nuances of these inequities for vulnerable populations?

What design, methodology and analysis strategies could be used?

How could the communities experiencing the inequities be involved?

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

Developed by


With support from:

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Case Study: Surveying Challenges with LGBTQ2S Homeless Youth

In this case study, you will learn

  • How failing to acknowledge the difference between sex and gender can result in severe inequities in health care, e.g. transgender homeless youth
  • Research strategies for identifying and responding to inequities in health care
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Presenter Profile

Dr. Alex Abramovich

Independent Research Scientist, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)

Assistant Professor, Dalla Lana School of Public Health, University of Toronto

Download Dr. Abramovich’s biography

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Case Study: Key Terms & Concepts

LGBTQ2S: The acronym used in The Health Researcher’s Toolkit for people who identify as lesbian, gay, bi-sexual, trans, queer or two-spirited. It can also include another Q for questioning. Presenters in the Toolkit might use variations of this acronym or “queer”.

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

Cisgender or cis: Identifying as the gender assigned at birth.

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

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Dr. Alex Abramovich Part I: Lecture Video

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Dr. Alex Abramovich Part I: Transgender & Cisgender

Transgender person

  • Identifies as a gender other than what that person was assigned at birth

Cisgender person

  • Identifies with the sex they were assigned

Use the term cisgender as well as transgender

  • To avoid portraying trans people as “the other”
  • Acknowledge that a person’s sex and gender may not align
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Dr. Alex Abramovich Part I: Trans Youth

Trans youth

  • Very high levels of homelessness
  • Under-represented in the emergency shelter system

Exact numbers of homeless trans youth unknown

  • Surveys have not asked
    • Sometimes thought to be invasive
  • Grouped trans with other sexual minorities
  • The question varied and/or was not asked of all youth
  • Youth fearful of identifying
  • Miss those who don’t access the system
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Knowledge Check-in

Why is it important to use the term cisgender?

C. was born a boy but never identified as male. What term best describes C.’s gender?

Exact number of homeless trans youth are unknown because

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Dr. Alex Abramovich Part II: Lecture Video

Institutional Erasure Definition:
Policies, rules and institutional culture make certain service users feel unwelcome or that they do not exist

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Dr. Alex Abramovich Part II: Institutional Erasure

Institutional erasure

  • Policies and procedures ignore or invalidate experience of transgender and non-binary people
  • Cisgender expectations that equate a person’s sex with their gender
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Dr. Alex Abramovich Part II: Discrimination and Health

Discrimination about gender identity impacts health

Inclusive standardized models of care

  • Make all service users feel acknowledged and welcomed
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Case Study Summary I

Trans youth homelessness

  • How failing to acknowledge the difference between sex and gender can result in severe inequities in health care

Population with many health care needs within the health care system

  • Violence by other service users
  • Institutional erasure
    • Transphobic/cisnormative policies, procedures and accepted staff behaviour
    • Feel unwelcome/invisible
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Case Study: Summary II

Data collection methods will include trans and non-binary people if the methods

  • Recognize that sex assigned at birth may be different from gender identity
  • Are standardized so that all service users are asked the same questions about gender identity
  • List identity options so that respondents can see themselves reflected
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Case Study Summary III

Resulting findings can be used to improve health equity

  • Reshaping policies and procedures
  • Educating health care providers
  • Making trans people visible in forms, in-take processes and facilities
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Reflection

What are other populations that face institutional erasure because of assumptions about sex and/or gender?

What are research methods that we can employ to reach such populations?

Are there particular strategies to employ in the research design, implementation, analysis and reporting phases to ensure that health-related institutions will engage in acknowledging overcoming institutional erasure?

Resources

Bazeley, P. (2010) “Computer-assisted integration of mixed methods data sources and analyses”, Sage Handbook of Mixed Methods in Social and Behavioral Research, Tashakkori, A and Teddlie, C. (Eds) 2010, Sage, California.

Braveman, P and S. Gruskin, “Defining equity in health”, Journal of Epidemiology and Community Health, 57:4

http://jech.bmj.com/content/57/4/254

Fetters, M. D., L. A. Curry, and J. W. Creswell, “Achieving Integration in Mixed Methods Designs - Principles and Practices”, Health Services Research, 2013; Dec: 48.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40978...

Hankivsky, O., & Cormier, R. (2009). Intersectionality: Moving Women’s Health Research and Policy Forward. Vancouver: Women’s Health Research Network

http://bccewh.bc.ca/wp-content/uploads/2012/05/200...

Canadian Professional Association for Transgender Health

http://www.cpath.ca/

My Guide to Caring for Trans and Gender-diverse Clients

https://www.rainbowhealthontario.ca/TransHealthGui...

Rainbow Health Ontario Resource Database

https://www.rainbowhealthontario.ca/resources/?ord...

Trans Pulse Project

http://transpulseproject.ca/