Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients – A Study of Pain Rehabilitation

Abstract

ObjectiveThere is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.MethodsIn the overarching project named “Equal care in rehabilitation” we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.ResultsThe process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.ImplicationsThe clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.ConclusionsThus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

“…Gender is defined as the social and relational aspects of sex, rather than as a fixed state [34,36]. In terms of equal care and rehabilitation, gender often intersects with other social categories such as origin of birth, ethnicity, educational level, socioeconomic status, or home district/region of living [37]. In general, gender hierarchies and stereotypes leads to limitations in the participation and potential of the individual [38,39].…”

Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective

“…This study was part of an overarching research project in northern Sweden named Equal care in rehabilitation, which combines quantitative ( 19 , 20 , 36 ) and qualitative methods ( 35 , 37 ). In this substudy, we used a qualitative approach ( 38 , 39 ) to focus on and deepen our understanding of patients’ perceptions and experiences.…”

“…To our knowledge, few studies have explored inequalities in assessment or pain rehabilitation from the patient's perspective. In a research project about equal care in pain rehabilitation, we investigated various aspects of gendered and social processes ( 19 , 20 , 35 – 37 ). Further identification of potential biases and inequalities in accessing rehabilitation resources, as perceived by individuals seeking help for long-term pain at a specialised rehabilitation clinic, is crucial.…”

Gender Medicine and Physiotherapy: A Need for Education. Findings from an Italian National Survey

“…The World Health Organization (WHO) focuses attention on the gender dimension, indicating how indispensable the development of research in the area of medicine is for inequities [ 8 ]. The WHO has developed a Gender Policy to ensure that all research programs and projects are structured with a gender perspective and this is done in a sustainable and systematic way [ 9 ]. Since 2018, in Italy it has been guaranteed that medicine is gender oriented in all its applications (and, therefore, also in physiotherapy) [ 10 ].…”