Ineke Klinge

Implementation of diversity in healthcare practices: barriers and opportunities.

OBJECTIVE The aim of this study is to investigate to which extent diversity is part of current healthcare practices and to explore opportunities and barriers in the implementation of diversity dimensions in healthcare practices. METHODS Nine in-depth, semi-structured interviews and three focus groups were conducted in three healthcare settings (mental health, hospital, nursing home care). RESULTS Results demonstrate that (the potential of) diversity is an ambiguous issue; diversity is said to be important, but this has not led to adjustments of the neutral, disease-oriented approach of patients. If recognized at all, diversity is reduced to one dimension (sex). Barriers in the implementation of diversity relate to: (a) lacking awareness and knowledge of diversity, (b) poor information and communication, and (c) organizational constraints. Opportunities to implement diversity in healthcare include: (d) an emerging sense of urgency to attend to diversity, (e) the development of good practices, and (f) the political climate. CONCLUSION Various barriers and some opportunities for the implementation of diversity in healthcare practices have been identified. There is an ambiguity in how professionals deal with diversity. As a result, the neutral approach remains dominant in practice and policy. PRACTICE IMPLICATIONS In order to raise the awareness and enhance the competence of professionals, educational programmes and learning networks are required.

Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination

BackgroundOur aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of women. We provide an outline on the crucial issues and debates based on the recent literature published in leading gender medicine journals. Intersectionality was applied in order to help categorise the knowledge.MethodsKey terms (HPV, cervical cancer) were screened in Gender Medicine, Journal of Women’s Health and Women & Health from January 2005-June 2012. Additional searches were conducted for topics insufficiently mentioned, such as HPV vaccination of boys. In total, 71 publications were included (56 original papers, four reviews, six reports, three commentaries, one editorial and one policy statement).ResultsResearch reveals complexity in the way various subgroups of women adhere to cervical screening. Less educated women, older women, uninsured women, homeless women, migrant women facing language barriers, women who have sex with women and obese women participate in Pap smears less frequently. A series of barriers can act to impede decisions to vaccinate against HPV.ConclusionsBoth male and female controlled preventive methods and treatment measures should be developed in order to tackle HPV infection and different strategies are needed for different subgroups. A substantial discussion and research on alternative methods of prevention was and is lacking. In future research, sex and gender aspects of HPV-related diseases of boys and men as well as subgroup differences in HPV risk need to be addressed.

Transforming Research Methodologies in EU life sciences and biomedicine: gender sensitive ways of doing research

This article describes how methodologies of EU-funded research within the life sciences and biomedicine have recently become more gender sensitive. This transformation is the result of the Gender Impact Assessments of the EU Fifth Framework Programme, commissioned in 2000-1. The authors assessed the research programme for life sciences, which includes a large health-related component. The new guidelines for research emphasize the need for clear terminology for concepts of sex and gender and for a distinction to be made between the two, for both life sciences and health research. Attention to possible sex differences, even in preclinical research, as well as to effects of gender, will lead to more adequate research data that serve the health of both men and women. The transformation to research becoming more gender-sensitive is further discussed in the context of feminist theory on the body. Being fully aware of the fact that what is happening in bodies is mediated by particular technologies, the authors make an appeal to invest in concepts that take the living and changing body into account.

Mainstreaming Sex and Gender Analysis in Public Health Genomics

BACKGROUND The integration of genome-based knowledge into public health or public health genomics (PHG) aims to contribute to disease prevention, health promotion, and risk reduction associated with genetic disease susceptibility. Men and women differ, for instance, in susceptibilities for heart disease, obesity, or depression due to biologic (sex) and sociocultural (gender) factors and their interaction. Genome-based knowledge is rapidly increasing, but sex and gender issues are often not explored. OBJECTIVE To explore the implications of a sex and gender analysis for PHG. METHODS We explore genome-based knowledge in relation to sex and gender aspects using depression as an example, gender equality, and the intersection of sex and gender with other social stratifiers such as ethnic background or socioeconomic status. RESULTS We advocate a sex- and gender-sensitive genomics research agenda alongside studies that provide sex-disaggregated data rather than controls based on sex. Such a research agenda is needed to guide research on how genomics is understood and perceived by men and women across groups, and for the equitable and responsible translation of such knowledge into the public health domain. CONCLUSIONS Including sex and gender analysis in PHG research will not only shed more light on phenomena such as diseases with a higher prevalence in either men or women, but will ultimately lead to gendered innovations by way of exploring how gendered and cultural environments increase or safeguard genetic predispositions.

Maintaining gender sensitivity in the family practice: facilitators and barriers

OBJECTIVE This study aims to identify the facilitators and barriers perceived by General Practitioners (GPs) to maintain a gender perspective in family practice. METHODS Nine semi-structured interviews were conducted among nine pairs of GPs. The data were analysed by means of deductive content analysis using theory-based methods to generate facilitators and barriers to gender sensitivity. RESULTS Gender sensitivity in family practice can be influenced by several factors which ultimately determine the extent to which a gender sensitive approach is satisfactorily practiced by GPs in the doctor-patient relationship. Gender awareness, repetition and reminders, motivation triggers and professional guidelines were found to facilitate gender sensitivity. On the other hand, lacking skills and routines, scepticism, heavy workload and the timing of implementation were found to be barriers to gender sensitivity. CONCLUSION While the potential effect of each factor affecting gender sensitivity in family practice has been elucidated, the effects of the interplay between these factors still need to be determined.

The policy implications of gender mainstreaming for healthcare research in the EU

Scientific and technological progress in the life sciences and modern biotechnology is continuing at a breathtaking pace. At the same time, the potential implications for individuals and society are giving rise to intense debate. This article gives a background to the European Institute of Women’s Health (EIWH) and the work of the organisation in contributing to and developing policy at a European level. We will identify the policy issues related to gender-based healthcare research arising from the EU 6th Framework Programme for Research, which was introduced this year, and the implications for the EU Public Health Strategy. Additionally, the issues of personalised medicine and the promise of biotechnology for improved medicines and healthcare will be addressed from a gender perspective. What are the prospects in the medium and long term? How can we best address the ethical and socio-economic implications?

Female Bodies and Brittle Bones: An Analysis of Intervention Practices for Osteoporosis

an ever-deeper level. It seems the privileged way to obtain knowledge on life processes, for instance on ageing of the body. However, science and technology studies have criticized the concept of ’discovering’ the body (and nature) (Latour, 1987). The claim is made that biomedical knowledge cannot directly ’mirror’ natural reality. On the contrary, the production of scientific knowledge is a human enterprise and in accordance with operative norms and values -in short, with social-cultural conditions. Consequently, scientific knowledge has to be considered as historical and local. Analysing the body poses a particular challenge to feminists. As daughters of the heritage which Simone de Beauvoir spelled out in The Second

Gene technology: also a gender issue. Views of Dutch informed women on genetic screening and gene therapy.

The reported research was conceived as a pilot study to explore the views of women on the implications of the analysis of the human genome. The data were gathered by interview and questionnaire from a group of Dutch women, most likely to have an informed opinion. However, even women who were assumed to be informed express a serious lack of knowledge. Nevertheless, they mention a whole range of problematic issues. Overall, women are likely to think that gene technology does affect them differently than it does men. They draw attention to the social reality of womens lives, mentioning the greater responsibility of mothers for the embryo and childbirth and pointing to the fact that women are subjected to more complicated and painful examinations. In the public debate attentional for gender implications of gene technology is lacking. A plea is made to improve the quality of the debate by integrating sex and gender specific issues.

Waarden aan het werk. Vrouwelijke coaches en loopbaanbegeleiders over de betekenis van coaching

SamenvattingDe afgelopen jaren is er veel aandacht geweest voor de begeleiding van mensen naar (ander) werk. Veel vrouwen startten als zelfstandig coach of loopbaanadviseur om mensen met gezondheidsproblemen te re-integreren in maatwerk trajecten. De dienstverlening en achterliggende motieven en ervaringen van deze vrouwelijke coaches zijn focus van onderzoek geweest in deze kwalitatieve studie, die inzicht biedt in de factoren die een rol spelen in het groeiende veld van re-integratie en loopbaandienstverlening door vrouwelijke coaches. Het onderzoek leert ons dat de geïnterviewde coaches behalve traditioneel loopbaansucces, persoonlijke groei ofwel psychologisch succes in werk belangrijk vinden. Zij willen deze waarden uitdragen in hun dienstverlening. Bij het coachen van anderen zien zij ‘vrouwelijke kwaliteiten’ zoals inlevingsvermogen als voordeel. Dit draagt vervolgens bij aan hun eigen persoonlijke groei. Op basis van de resultaten worden valkuilen gesignaleerd op het gebied van de kwaliteit van dienstverlening en het bewaren van afstand tot de cliënt. Hierover worden aanbevelingen ter verbetering gedaan.AbstractValues at work. – Female coaches and career counsellors about the meaning of coaching. Recently there has been much attention for guiding people to (other) work. Many women started as independent career coach or counsellor to reintegrate people with health problems in tailor made programs. The services, experiences and motives of these female coaches has been the focus of research in this study. This qualitative study provides insight into the factors that play a role in the growing field of rehabilitation and career services by female coaches. The study shows that besides traditional career success, personal growth or psychological success in work is important to the interviewed coaches. They want to propagate these values into their service. Coaching others, in which ‘female qualities’ such as empathy are considered an advantage, contributes to their own personal growth. Pitfalls exist in terms of quality of service and keeping distance from the client. Recommendations are made.