Background
Discussion
What is sex? What is gender?
Measuring and understanding sex and gender
Gender construct | Definition | Examples of potential questions for implementation research | Examples of potential questions for implementation practice | Examples of measures |
---|---|---|---|---|
Represent the behavioral norms applied to men and women in society, which influence individuals’ everyday actions, expectations, and experiences. Gender roles often categorize and define individuals within the family, the labour force, or the educational system. May form the basis for stereotypes. | How can considering gender roles help us understand and anticipate barriers and opportunities facing health-care professionals in the uptake of new interventions? | How can considering gender roles help inform dissemination strategies that are successful in reaching different audiences where they are? | The Gender Role Conflict Index [73] | |
Describes how we see ourselves, and are seen by others, as female or male, or across a feminine-masculine continuum. Individuals may also self-identify dynamically along the continuum of gender-queer and/or transgender. Gender identity affects our feelings and behaviors. | Do a range of gender identities need to be considered when asking the question, “for whom does this implementation strategy work and under which circumstances?” | Will the reach of the implementation intervention extend to male, female and transgender individuals? | The BEM sex role inventory [74] | |
The Personal Attributes Questionnaire [75] | ||||
Should the content of the implementation intervention consider gender identity or sexual orientation? | The Conformity to Masculine Norms Inventory [76], | |||
A two-step approach to measuring gender identity first asks individuals to indicate their sex assigned at birth (male/female), and then asks the same individuals how they currently self-identify (male, female, trans male/trans man, trans female/trans woman, gender queer/gender non-conforming) [39, 40]. | ||||
Refers to how we interact with or are treated by people in the world around us, based on our ascribed or experienced gender. | How might the outcomes of implementation interventions differ by sex and gender according to whether the degree to which the geographic setting is culturally homogeneous, diverse or gender equitable? | What are the implications of an implementation intervention being communicated or delivered to women only, men only, men and women separately or together? How is this mediated by cultural context? | The Self-Perceived and Self-Reported Gender Equality scale [77]. | |
Reflects the distribution of power between men and women in the political, educational, and social institutions in society. The institutionalized aspect of gender also shapes social norms that define, reproduce, and often justify different expectations and opportunities for men and women. | If particular decision-maker groups value, use, or require, different kinds of knowledge, have you considered how institutionalized gender might play a role? How might this change over time? | How can dissemination messages be crafted in a way that responds to sex and gender–related factors without reproducing or exploiting any negative stereotypes embedded in institutionalized gender? | The use of qualitative methods (e.g. case studies, ethnography, narrative and descriptive qualitative approaches etc.) can be used to explore concepts of institutionalized gender, and to gain a more in-depth understanding of gender as a barrier or enabler. |
The case for considering sex and gender in implementation research methods
Some research questions to drive the selection of methods
• Are theories of behaviour change (i.e. processes of reasoning or reflection) equally applicable across sexes, genders and other intersecting variables? |
• How does consideration of sex, gender and diversity affect the assessing of barriers and supports to uptake of evidence-informed practice, programs, policies? |
• How do prevailing gender norms or gender roles serve as barriers or enablers to the uptake of evidence-informed practices, programs, policies? |
• When and how should implementation interventions be tailored to the sex, gender and diversity of the target audience? |
• Do cognitive and emotional learning strategies differ across sexes or genders, and if so how? |
• When and how should the wording or messaging included in the implementation intervention be tailored differently across sex, gender and other identity characteristics? |
• How does the implementation intervention increase or decrease gender inequities in socio-economic status, cultural or ethnic groups, and political contexts? |
• Does the implementation intervention work differently for sub-groups of men, women and gender-diverse people, and if so, how? |
• When using participatory/collaborative or integrated knowledge translation research approaches, does the sex and gender of the researchers and knowledge users matter, and if so, how? |
• How do gender relations as a function of dyads or interpersonal dynamics within an organization, community, workplace or institution influence the outcome of the intervention? |
• Are there unintended impacts of implementation that exacerbate or diminish sex, gender or other diversity-related inequities? |
• Has the systematic review of the effectiveness of implementation interventions considered evidence related to sex and gender? |
• Has the literature review and analysis of the know-do-gap considered gender roles, gender identity, gender relations, institutionalized gender? |
• Does the monitoring and evaluation plan for the intervention collect data on sex, gender and diverse factors, and include a strategy for assessing and mitigating inequitable outcomes? |
• Has the assessment of barriers and facilitators of the use of evidence-informed practices, programs, policies considered gender roles, gender identity, gender relations, institutionalized gender? |
• Has the process by which local or targeted adaptation of the evidence-informed practices, programs, policies considered cultural contexts of gender roles, gender identity, gender relations, institutionalized gender? |
• Has the implementation intervention been tailored to address sex, gender or other identity or diversity-related characteristics identified in the barriers assessment? |
• Has knowledge use (uptake of the practice, program, policy) been reported by sex, gender, and other population characteristics such as age, socioeconomic status etc? |
• Have health outcomes (impact of adopting the practice, program, policy) been reported by sex, gender, and other population characteristics? |
• Has the impact of unintended consequences of implementation been reported by sex, gender, and other population characteristics? |