Measurement of gender as a social determinant of health in epidemiology—A scoping review

Abstract

Background The relevance of gender as a social determinant of health and its role in the production of health inequalities is now broadly acknowledged. However, the plethora of existing approaches to capture gender, which often stem from disciplines outside of epidemiology, makes it difficult to assess their practicality and relevance for a given research purpose. We conducted a scoping review to 1) map the evidence of how gender can be operationalised in quantitative epidemiology and 2) design a tool to critically evaluate the measures identified. Methods We identified peer-reviewed articles in electronic databases (PubMed, Embase and PsycINFO). Eligible sources described the quantitative operationalisation of the social dimension of gender. With the help of a newly developed checklist, we assessed their relevance from an analytical perspective (e.g. intersectionality) and their potential for implementation in epidemiology. Results Gender measures principally assessed gender roles and norms, gender-based discrimination and violence, and structural gender (in)equality. Of the 344 measures included in this review, the majority lacked theoretical foundation, and tended to reinforce the binary understanding of gender through stereotypes of femininity and masculinity. Only few measures allowed for an intersectional approach and a multilevel understanding of gender mechanisms. From a practical point of view, gender measures demonstrated potential for use in varied populations and contexts. Conclusions A range of gender measures are readily available for epidemiological research, addressing different levels and dimensions of gender as a social construct. With our theory-informed, practice-driven scoping review, we highlighted strengths and limitations of such measures and provided analytical tools for researchers interested in conducting intersectional, gender-sensitive analyses.

The Operationalisation of Sex and Gender in Quantitative Health–Related Research: A Scoping Review

“…In line with a recently published scoping review by Miani and colleagues [ 30 ], we found that the majority of instruments are based on a binary distinction between femininity and masculinity, although, in many cases, they are not considered mutually exclusive. We identified several instruments that measure the participants’ degree of belonging to a sex and/or gender category or their conformity with stereotypical gender roles.…”

“…Furthermore, we conducted a thorough and comprehensive search following the PRISMA Extension for Scoping Reviews, which allowed a broad range of approaches to measuring sex and/or gender to be included within our scoping review. This distinguishes our review from previous reviews that focused on gender only [ 30 , 31 ]. Thus, our scoping review clearly demonstrates that further elaboration or new development of instruments to operationalise sex and gender comprehensively are needed to be able to assess the impact of sex/gender dimensions on health and to fulfil the requirements of expert associations, funding agencies, and scientific journals to consider sex and gender in research.…”

“…As a first step, we set out to map and evaluate the existing literature about the operationalisation of sex and gender in health–related research. Previous work to map and evaluate existing literature has mostly focused on the operationalisation of gender [ 30 , 31 ] and not on providing a broad and systematic overview. With this scoping review, we are trying to fill this gap and encourage a discussion about the operationalisation of sex and/or gender that inspires researchers to experiment with different instruments.…”

Let's bring emergency departments out of the closet: Improving care for LGBTQIA+

“…While in everyday language, sex and gender are often used interchangeably, distinctions between the terms are now recognised within legal and academic circles. Broadly, sex refers to biological characteristics, while gender refers to a sociocultural construct 3 . Biological sex is often assigned at birth based on anatomical characteristics; however, it can also be defined by chromosomal sex, with phenotypical variation influenced by hormones.…”

“…Broadly, sex refers to biological characteristics, while gender refers to a sociocultural construct. 3 Biological sex is often assigned at birth based on anatomical characteristics; however, it can also be defined by chromosomal sex, with phenotypical variation influenced by hormones. Although biological sex is often thought of as a male and female binary, intersex and hormonal variations occur in individuals, such that sex may similarly be considered across a spectrum.…”