Designing and Conducting Gender, Sex, & Health Research
Publication Year: 2012
This book provides the first resource dedicated to critically examining gender and sex in study designs, methods, and analysis in health research. In order to produce ethical, accurate, and effective research findings it is vital to integrate both sex (biological characteristics) and gender (socially constructed factors) into any health study. This book draws attention to some of the methodological complexities in this enterprise and offers ways to thoughtfully address these by drawing on empirical examples across a range of topics and disciplines.
- Front Matter
- Back Matter
- Subject Index
Part I: Context and Concepts
- Chapter 2: Sex and Gender: Beyond the Binaries
- Chapter 3: Implications of Sex and Gender for Health Research: From Concepts to Study Design
- Chapter 4: Approaches to the Measurement of Gender
- Chapter 5: Measuring Biological Sex
- Chapter 6: Fieldwork: Observations and Interviews
- Chapter 7: Visual Methods in Gender and Health Research
- Chapter 8: Secondary Analysis—Gender, Age, and Place: Gender, Place, and the Mortality Gap between Urban and Rural Canadians
- Chapter 9: Content and Discourse Analysis
- Chapter 10: Approaches to Examining Gender Relations in Health Research
- Chapter 11: Developing a Gender Role Socialization Scale
Copyright © 2012 by SAGE Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Library of Congress Cataloging-in-Publication Data
Designing and conducting gender, sex, and health research / edited by John L. Oliffe & Lorraine Greaves.
Includes bibliographical references and index.
ISBN 978-1-4129-8243-6 (pbk.)
1. Medicine—Research. I. Oliffe, John L. II. Greaves, Lorraine.
R850.D47 2012 610.72—dc22 2010054555
This book is printed on acid-free paper.
11 12 13 14 15 10 9 8 7 6 5 4 3 2 1
Ever present are questions about how to do gender, sex, and health research. Yet, generic study designs and methods do not always meet the specific needs or interests of students and health researchers who want to explicitly engage gender and/or sex in their work. Of course, there are a number of ways to thoughtfully guide the efforts of gender, sex, and health researchers. One strategy is to draw together established researchers and students to share their approaches and experiences as a means of building capacity while advancing the empirical, methodological, and theoretical aspects of the enterprise. Worthy of mention here is such a collective, the Canada-based research group NEXUS, from which this volume has emerged. During its tenure from 2003 to 2009, the NEXUS group brought together an interdisciplinary team of researchers and students to engage the concepts of gender, diversity, and place in a variety of health and illness issues. As the NEXUS infrastructure funds ended, so too did some of the formal collaborations the group had facilitated. Yet, from NEXUS came many great moments and achievements, and some synergistic collectives continue today, albeit less formally. As NEXUS ended, there was interest and energy to further share our insights about designing gender, sex, and health research. With the support of NEXUS, and the expertise and hard work of research manager Stephanie Coen, we developed a book proposal that eloquently made the case for this volume, Designing and Conducting Gender, Sex, and Health Research. When SAGE enthusiastically responded to the ideas put forward in that proposal, the chance to chronicle and extend the work of NEXUS was realized.
The philosophy of NEXUS had always been to develop capacity through sharing experiences and expertise with others, and those goals drive this volume. We were also interested in soliciting contributions from gender, sex, and health researchers who had not formally linked to NEXUS but with whom we had always wanted to work. Fortunately, we were able to recruit an array of expert contributors to ensure a high-quality volume for addressing design and methods issues. With the wonderful assistance of research assistant Christina Han, we were able to piece together and format all the authors' contributions and send a full first draft, and the [Page viii]revised finished product, to SAGE. What follows is a four-part, 14-chapter volume, a collection dedicated to advancing gender, sex, and health research.
Part I provides a historical overview detailing the trends and turns that led to the current state of research in gender, sex, and health. Part II includes four chapters that unpack design considerations to promote understandings about different conceptual and operational definitions, and the implications of these in building research design. Part III unveils six chapters that foreground various methods using empirical examples to contextualize those diverse strategies. Part IV engages issues around public policy and knowledge exchange processes and products to close out the volume.
In sum, what follows is a much needed collection that distills design, methods, and dissemination considerations for gender, sex, and health research. While each chapter and section has the strength and substance to stand alone, as a collection, the volume also has great potential to conceptually advance the field of gender, sex, and health research.and
About the Editors and Contributors[Page ix]
JOHN L. OLIFFE
John L. Oliffe is an associate professor at the University of British Columbia, Canada. His men's health research program includes studies addressing prostate cancer, depression, South Asian Canadian immigrant men, smoking patterns of fathers, and youth sexual health. He has published methodological, theory-based, and empirical articles and chapters describing linkages between masculinities and men's health promotion in the context of varying health practices and diverse illness experiences.
Lorraine Greaves is a senior investigator with the British Columbia Centre of Excellence for Women's Health, and a clinical professor in the School of Population and Public Health, Faculty of Medicine, University of British Columbia. She has a doctorate in medical sociology from Monash University and has published widely on a range of women's health issues and the integration of gender and women's health into program, policy, and practice. Her special areas of research interests focus on women, substance use, trauma, and violence. Her extensive research on women, gender, and tobacco use and policy has influenced national and international bodies. She has received numerous awards including an honorary doctorate from the University of Ottawa for her contributions to women's health in Canada.About the Contributors
Donna Akman is a psychologist with the Women's Mental Health Program at the Centre for Addiction and Mental Health, and an assistant [Page x]professor in the Department of Psychiatry at the University of Toronto, Canada. Her clinical and research interests focus on feminist issues in psychology and psychotherapy.
Alisha Ali is an associate professor in the Department of Applied Psychology at New York University. Her research investigates social and cultural influences on women's depression, including the effects of emotional abuse, harassment, and discrimination. She is coeditor, along with Dana Crowley Jack, of the book Silencing the Self Across Cultures: Depression and Gender in the Social World, published in 2010 by Oxford University Press. She is currently principal investigator on a series of studies examining economic empowerment programs for survivors of domestic violence.
JOAN L. BOTTORFF
Joan L. Bottorff is a professor at the University of British Columbia and director of the Institute for Healthy Living and Chronic Disease Prevention. Her program of research in cancer prevention and health promotion includes studies addressing tobacco reduction in a variety of populations, cancer screening, and health promotion among cancer patients and their families. In her research she has explored the social context of health behavior and has published both methodological and empirical articles focusing on gender influences.
Cathy Chabot is an anthropologist and is employed as the research manager with the Youth Sexual Health Team based at the University of British Columbia. She has extensive fieldwork experience in the area of social inequities and health, particularly in British Columbian settings. She received her master's in anthropology from Simon Fraser University in 2002.
NATALIE A. CHAMBERS
Natalie A. Chambers is an interdisciplinary doctoral student at the University of British Columbia Okanagan. She has participated in health research studies and coauthored publications on women and men's tobacco cessation during pregnancy, tobacco use of youth, First Nations women and tobacco, South Asian Canadian women's experiences of breast cancer, the health behaviors of immigrants and refugees in Canada, and models of First Nations chronic disease self-management and health governance.
[Page xi]GILLIAN EINSTEIN
Gillian Einstein is an associate professor in the Department of Psychology and the Dalla Lana School of Public Health, as well as founder and director of the Collaborative Graduate Program in Women's Health, at the University of Toronto. Her cognitive neuroscience and women's health research program includes studies addressing the neurobiological effects of cultural practices such as female genital circumcision/mutilation/cutting (FGC), the effects on memory of prophylactic oophorectomy in women carrying the BRCA1/2 gene mutations, and sex differences in sensitivity to touch. She has published on vision, Alzheimer's disease, sex differences, FGC, and women's health. She has edited and annotated a book of classical papers in hormones and behavior called Sex and the Brain (2007, MIT Press).
MARY JANE ESPLEN
Mary Jane Esplen is a clinician-scientist and professor in the Department of Psychiatry, Faculty of Medicine, University of Toronto, and director of the de Souza Institute. She is a therapist and researcher working in psychosocial oncology. She has a strong interest in developing measurement tools and support groups or therapy interventions for cancer genetics populations and individuals with cancer. She also has an interest in women's health issues and works with individuals in the area of body image and sexual health. She is the recent past president of the Canadian Association of Psychosocial Oncology.
Brendan Gough was appointed as chair in social psychology at Nottingham Trent University in 2007. He is a qualitative researcher interested in gender issues, especially concerning men and masculinities. He has published various papers on gender identities and relations that draw on discursive and psychoanalytic concepts, including areas such as sexism, homophobia, and men's health. Gough is coeditor of Qualitative Research in Psychology (Taylor & Francis) and Social & Personality Psychology Compass (Critical Psychology Section) (Blackwell). He has coproduced three books with various colleagues: Critical Social Psychology (with M. McFadden), Reflexivity in Qualitative Research (with L. Finlay), and Men, Masculinities, and Health (with S. Robertson).
REBECCA J. HAINES-SAAH
While writing this chapter, Rebecca J. Haines-Saah was a postdoctoral fellow at the Centre for Nursing and Health Behaviour Research at the [Page xii]University of British Columbia, with funding from the Social Sciences and Humanities Research Council of Canada and the Psychosocial Oncology Research Training Program (PORT). She holds a doctorate (2008) in behavioral health sciences from the Dalla Lana School of Public Health, University of Toronto. Her research interests include social theories of health and illness, gender and health, adolescent substance use, and analyses of tobacco and drug use in media and popular cultures.
JOY L. JOHNSON
Joy L. Johnson is the scientific director of the Canadian Institute of Health Research's Institute of Gender and Health and a professor in the School of Nursing at the University of British Columbia (UBC). Johnson's highly productive research program focuses on health promotion and health behavior change, and addresses social, structural, and individual factors that influence health behavior. A major thrust of her work focuses on sex and gender issues in substance use. Johnson has made extensive contributions in the field of tobacco research, and her work has been recognized with numerous awards including the UBC Killam Research Prize.
Shirin Kalyan received her doctorate in experimental medicine from the University of British Columbia in 2006, specializing in the stress-induced regulation of the immune system. Her research is concerned with sex and gender differences in the neuroendocrine control of the stress-response system that regulates chronic ailments such as osteoporosis, autoimmunity, and cardiovascular disease. As a translational scientist, Shirin facilitates knowledge sharing between disciplines and is able to design unique studies that bridge population, clinical, and basic sciences in the context of women's health research.
MARY T. KELLY
Mary T. Kelly is an independent research consultant and freelance writer. She holds a master of arts degree and provides qualitative-based services for health research investigators and their projects.
Aleck Ostry is a professor in the faculty of social sciences at the University of Victoria. He holds a Canada Research Chair in the Social [Page xiii]Determinants of Community Health and is also a Senior Scholar with the Michael Smith Foundation for Health Research in British Columbia. He has a master of science in health service planning, a master's in history (specializing in the history of public health), and a doctorate in epidemiology. He conducts an extensive program on the social determinants of health with a focus on rural health, food security, and nutrition policy.
Nancy Poole is the director of research and knowledge translation for the British Columbia Centre of Excellence for Women's Health in Vancouver, British Columbia, Canada. Poole has extensive experience in research and knowledge exchange relating to policy and service provision for women with tobacco and other substance use problems. She is well known in Canada for leadership in piloting online, participatory methods for knowledge generation and exchange, including virtual networks, collaboratories, and communities of inquiry/practice.
PAMELA A. RATNER
Pamela A. Ratner is a professor of nursing at the University of British Columbia and holds a Senior Scholar Award from the Michael Smith Foundation for Health Research. She has led research initiatives to inform practice and policy through analyses of the social contexts that create barriers to health, affect health seeking, and influence health system responses. In particular, she has examined how gender and diversity influence health behavior. Her specific research program has focused on cardiovascular risk reduction and the psychosocial determinants of health risk behavior. Ratner has a particular interest in latent variable modeling and health measurement. She is a member of the Institute Advisory Board of the Canadian Institutes of Health Research, Institute of Circulatory and Respiratory Health, and was elected a Fellow of the Canadian Academy of Health Sciences in 2007.
Robin Repta is a social science researcher at the Centre for Nursing and Health Behaviour Research at the University of British Columbia (UBC). She received a master's degree in human kinetics from UBC in 2006 and has continued to conduct qualitative gender and health research. Her current work focuses on social inequalities among tobacco-smoking teens, the representation of marijuana in Canadian newspapers, and the integration of sex and gender as variables in health research.
[Page xiv]STEVE ROBERTSON
Steve Robertson worked in the UK National Health Service (NHS) for more than 20 years before commencing a career in research. He secured an NHS Fellowship to complete his doctorate and an Economic and Social Research Council/Medical Research Council Interdisciplinary Fellowship to complete his period of postdoctoral study. His main interests and publications are around social theories of masculinity and their application to aspects of health and illness, but he has also worked on masculinity and disability; the sociology of (male) bodies; fathers and fatherhood; men, masculinity, and mental well-being; evaluating men's health programs; and men's engagement (or not) with health services. He has successfully completed two Florence Nightingale Foundation Travel Scholarships, and has worked with fellow academics, policymakers, and practitioners from Australia, the United States, and Canada. He has also acted as a consultant on gender and men's health to the UK Department of Health and the World Health Organization (Europe).
Cheryl Rolin-Gilman is the advanced practice nurse for the Women's Mental Health Program and the Addictions Program at the Centre for Addiction and Mental Health (CAMH) and a lecturer for the Department of Psychiatry and Faculty of Nursing at the University of Toronto. She has been working at CAMH since April 1999, when she also completed her master's degree in nursing. In the course of her studies, she focused on women's issues, particularly integrating feminist principles into practice. Prior to her work at CAMH, she held various nursing leadership positions. She was the professional practice leader and educator of the Mental Health Patient Service Unit at Sunnybrook and Women's College Health Sciences Centre. In that area, she worked with war veterans and developed her interest in trauma.
Lori Ross is a research scientist in the Social, Equity and Health Research Section of the Centre for Addiction and Mental Health and an associate professor in the Department of Psychiatry, Dalla Lana School of Public Health, and Lawrence S. Bloomberg Faculty of Nursing of the University of Toronto. Her research focuses on mental health and health service experiences of marginalized communities, with a particular focus on lesbian, gay, bisexual, and transgender populations.
[Page xv]RICHARD G. SAWATZKY
Richard G. Sawatzky is an associate professor of nursing at Trinity Western University, Canada. His research focuses on methods of patient-reported outcomes and quality-of-life measurement, and the intersections of spirituality, religion, culture, and other sources of diversity in various health care contexts. He has a particular methodological interest in the use of latent variable mixture modeling for examining sample heterogeneity with respect to individuals' self-reports about their health status and quality of life. He is a member of the International Society for Quality of Life Research and the International Society for Quality of Life Studies.
Toni Schofield is an associate professor at the University of Sydney, Australia. She has published widely in the sociology of gender, focusing on public policy and health. Her current research projects are diverse, including large publicly funded studies of prosecution and deterrence in workplace health and alcohol use and harm minimization among young people. As in her previous work, the principal object of inquiry is the social dynamics involved in “the problem” and how they generate barriers to and opportunities for interventions to address and redress it.
Jean Shoveller is a professor at the University of British Columbia, Faculty of Medicine, School of Population and Public Health, where she coleads the Social and Life Course Determinants of Health theme. She holds a Canadian Institutes of Health Research/Public Health Agency of Canada Applied Public Health Chair and a Senior Scholar Award from the Michael Smith Foundation for Health Research. Her program of research and training focuses on the social contexts of youth health inequities, with a particular emphasis on intervention to improve youth sexual health.
Amanda Slaunwhite is a doctoral student in the Department of Geography at the University of Victoria. Her research interests include gender-based analysis of mental health issues, health planning in northern communities, and occupational mental health. Slaunwhite is a recipient of the Canadian Institutes of Health Research Frederick Banting and [Page xvi]Charles Best Doctoral Award and is affiliated with the Western Regional Training Centre for Health Services Research. She is currently contributing to research related to the provision of mental health services in rural and remote communities, mental health care restructuring in British Columbia, and the utilization of health care services by persons with substance dependence issues.
Noreen Stuckless is an assistant professor in the Department of Psychiatry at the University of Toronto. She teaches psychology of women and gender-related courses at York University and the University of Toronto. She has coauthored publications involving domestic violence and the scale development of measures including those on attitudes toward revenge, cognitive bowel disorders, and the psychosocial effects of diagnoses of genetic mutations. Her current research is on interpartner violence and, in particular, how the violence affects women and their children.
Taryn Tang is an assistant professor in the Women's Mental Health Program, Department of Psychiatry, University of Toronto. She is interested in the cumulative and intersecting social and psychological determinants of mental health. This approach recognizes that multiple factors, such as gender, income, and ethno-racial identity, come together in distinct ways to influence health outcomes for individuals and groups. Her areas of research have focused on gender differences in migrant socioeconomic integration and mental health and mental illness stigma among ethno-racial communities in Canada.
Brenda Toner is the cohead of Social Equity and Health Research at the Centre for Addiction and Mental Health and a professor and head of the Women's Mental Health Program and the director of the Fellowship Program in the Department of Psychiatry at the University of Toronto. Toner has published and presented on a variety of health-related problems that are disproportionately diagnosed in women, including eating disorders, anxiety, depression, chronic pelvic pain, chronic fatigue, and irritable bowel syndrome. She is particularly interested in investigating factors in the lives of women that influence health and well-being, including gender role socialization, violence, discrimination, and body dissatisfaction.
The writing of Chapter 1 and the editing of this volume, along with the development of many ideas underpinning this enterprise, were made possible by the support of colleagues and partners at the British Columbia Centre of Excellence for Women's Health whose activities are supported by Health Canada, via the Centres of Excellence for Women's Health Program. The impetus for this volume originated with NEXUS, a research team on the social context of health behavior that was supported by the Michael Smith Foundation for Health Research. The views expressed are my own.
The writing of Chapter 4 was made possible by the career support provided to the first author by a Michael Smith Foundation for Health Research Senior Scholar Award.
Pamela A. Ratner
The author gratefully acknowledges the opportunity to think about and present many of her ideas first at the Institute of Gender and Health's Summer Institute in Vancouver, British Columbia, in June 2009. Thanks go also to the Committee on Degrees in Studies of Women, Gender, and Sexuality at Harvard University for the invitation of a visiting professorship and providing a fecund environment in which to revisit the ideas and write Chapter 5 during Spring 2010.
The writing of Chapter 6 was made possible by the career support provided to the second author by a Canadian Institutes of Health Research (CIHR) and Public Health Agency of Canada (Applied Public Health Chair in Improving Youth Sexual Health) and Michael Smith Foundation for Health Research Senior Scholar Award. The empirical examples shared are drawn from the CIHR-funded projects—Sex, Gender and Place: An Analysis of Youth's Experiences With Sexually Transmitted Infection Testing—as well as research funded by the British [Page xviii]Columbia Medical Research Foundation—Investigating the Experience of Teenage Pregnancy in Prince George, British Columbia.
Cathy Chabot and Jean Shoveller
Rebecca J. Haines-Saah was a recipient of postdoctoral fellowships from the Social Sciences and Humanities Research Council of Canada and the Psychosocial Oncology Research Training program of the Canadian Institutes of Health Research while writing Chapter 7. The Smoke in My Eyes study was funded by a student research grant from the Canadian Tobacco Control Research Initiative.
Rebecca J. Haines-Saah
The development of the scale and the writing of Chapter 11 were made possible by the support of a grant from the Social Sciences and Humanities Research Council. In addition, support to the Centre for Addiction and Mental Health for salary of scientists and infrastructure has been provided by the Ontario Ministry of Health and Long-Term Care. The views expressed in this chapter do not necessarily reflect those of the Ministry of Health and Long-Term Care.
Much of the conceptual material in Chapter 12 was developed over more than a decade of research funded by the Australian Department of Health and Ageing, the Australian Research Council (ARC), and the Australian Health Policy Institute. Empirical examples are drawn from this work and further research supported by the Academy of the Social Sciences in Australia. The prodigious research and support of my colleague and friend Raewyn Connell have been central to the approach and methods outlined in the chapter. So, too, have the numerous discussions on this subject with Anthony Nolan. I am also indebted to my current colleagues working with me on a large ARC-funded study of alcohol use and harm minimization.
The writing of Chapter 13 was made possible through a range of projects employing the use of virtual communities, which have been sponsored by the British Columbia Centre of Excellence for Women's Health (BCCEWH) in Vancouver, funded in part by Health Canada. The author thanks the Promoting Health in Women research team at BCCEWH for thoughtful discussions of the role of virtual communities as mechanisms for knowledge translation and feminist action research, and Mary Lasovitch for development editing support.
[Page xix]The editing of this volume, contributions to Chapters 7 and 10, and the writing of Chapter 14 were made possible by the career support provided by a Canadian Institutes of Health Research (Institute of Gender and Health) New Investigator Award and a Michael Smith Foundation for Health Research Scholar Award. The empirical examples shared are drawn from a program funded by the Canadian Institutes of Health Research (Institute of Gender and Health)—Families Controlling and Eliminating Tobacco (FACET). Special thanks to Mary Kelly, Christina Han, Anna Chan, and Tina Thornton for their assistance, edits, and thoughtful reviews of the earlier drafts of Chapter 14.
John L. Oliffe
Many thanks to the reviewers of our book proposal and volume for their thoughtful feedback, guidance, and enthusiasm for this work.
John L. Oliffe and Lorraine GreavesUniversity of GlasgowBoston University and Harvard Medical SchoolUniversity of PhoenixUniversity of North Carolina at Charlotte[Page xx]
The impetus for this book came from our recognition that gender, sex, and health research has thoughtfully addressed important and diverse issues, and indeed is essential to achieve good, ethical science necessary to improving health. Yet it is still all too often found occupying the periphery of health research. How do we change this going forward?
Parts I and II of this volume highlighted the history, contexts, and relevance, along with an array of design considerations and options whereby sex and/or gender can deliberately, strategically, and rightfully be considered central to health research. In this context the “So what?” question does not yield nearly as much as the proactive rephrasing “So what can sex and gender reveal about health and particular disease and illness issues?”
The six-part offering in Part III provided a palette of methods for delivering on that potential. Contextualized within diverse health and illness issues, the gender and sex methods described revealed an eclectic assortment of tools from which to choose. By no means are all possibilities captured or fully represented here; instead, prospects and pathways for getting started are raised. Indeed, rather than attempting to prescribe a chronology or combination, the offerings in Part III afford many ways and means for addressing sex, gender, and health issues.
Part IV mapped some policy, process, and product terrain that is less often explicitly connected to methods. Yet, again, threaded through these chapters are important considerations about how gender and sex research connects to wider political considerations, community partnerships, and product development.
There are two additional considerations that we want to leave you with. First, the advancement of gender, sex, and health research is contingent on sustaining an ongoing dialogue about concepts, theories, design, and methods. While we might engage in this enterprise by explicitly self-labeling as experts in men's health, women's health, or gender and health, and/or as feminists, masculinists, or social or bench scientists, there is a great deal to be gained from stepping out (even if only for a moment!) of those [Page 244]compartments and categories. Through meaningfully connecting with others within the enterprise of gender, sex, and health research and consciously developing and embracing transdisciplinary approaches, the influence and impact of our collective work may be realized sooner rather than later.
Second, capacity building may be best achieved by a commitment to a clear goal of mainstreaming gender in addition to continuing to develop specialized knowledge and experience in sex, gender, and health, so that gender and sex permeate the design and doing of all health research and ultimately clinical practice and policymaking. To that end, sharing this volume widely with both researchers and research users might be a strategic step toward achieving that goal.