Abstract
The first step in precision health is the incorporation of sex and gender-based considerations and increasingly, a number of national organizations have instituted policies to support and encourage this practice. However, perspectives of trainees and allied research personnel on incorporation of sex and gender into research is lacking. We assessed trainee (undergraduate and graduate students, post-doctoral fellows, clinical trainees) and allied research personnel (study nurses, laboratory managers) perspectives on the barriers to incorporating sex and gender into their own university-based health research and recommendations to improve the process. Two separate focus groups were completed, and a qualitative analysis was employed to derive themes within perceived barriers and solutions. Participants described three overarching themes consistent with barriers including, lack of knowledge and skill, lack of applicability and feasibility, and lack of funding agency and institutional culture. Participants recommended: (1) increasing awareness and skill of incorporation of sex and gender considerations into health research; (2) implementing practical education curricula to facilitate understanding; and (3) fostering greater transparency and accountability by funding organizations and journal editors. Sex and gender considerations in research contribute to precision health, drive innovation and foster breakthroughs in science and medicine.
Similar content being viewed by others
Introduction
Sex (biological attributes) and gender (social–cultural) considerations in research are important factors in precision health where diagnoses, treatment, and prevention strategies take individual variability into account (Collins and Varmus, 2015). Aspirin therapy, one of the most commonly used cardiovascular (CV) therapies, is effective at reducing the risk for CV events for both females and males (Berger et al., 2006), however, women with coronary heart disease are less likely to use aspirin than men, which may reflect gendered effects such as socioeconomic position or type of health insurance (Opotowsky et al., 2007). COVID-19 infection rates are similar by sex, though globally mortality is notably greater in men compared to women (Global Health 5050, 2020). Sex likely plays a role in differences in disease severity as the female immune system demonstrates a stronger response to viral infection than that of males (Schurz et al., 2019). Conversely, handwashing (Johnson et al., 2003), compliance with public health measures (Hamel and Salganicoff, 2020) and mask-wearing (De La Vega et al., 2020) is less common in men compared to women, suggesting gendered behaviors may also contribute to differences in outcomes (Ahmed and Dumanski, 2020). Including both a sex and gender element to health research contributes to the understanding of different clinical manifestations, preventive and treatment strategies as well as outcomes of disease in women, men, and gender minorities (Mauvais-Jarvis et al., 2020). While there is increasing emphasis on the importance of incorporating sex-based and gender-based analysis (SGBA) in health research, little is known about trainee perceptions of barriers and opportunities for including sex and gender-based considerations in their work. It has been suggested that earlier exposure to new concepts is met with greater uptake; as such, targeting scientists in the training stages may have the potential for the greatest impact (Andrew, 2013; Murray and Haubl, 2007; Regensteiner et al., 2019; Song et al., 2018). We assessed trainee and allied research personnel perspectives on barriers to the incorporation of sex and gender considerations into health research and recommendations to improve the process.
Methods
Study design and setting
We conducted focus groups of health research (biomedical, clinical, health services, population health) trainees (undergraduate, M.Sc. and Ph.D. students, post-doctoral fellows, clinical trainees) and allied research personnel on two occasions: first at the University of Calgary (19 March 2019, Calgary, Canada) and next at the 2019 Organization for the Study of Sex Differences (OSSD) and International Society of Gender Medicine Annual joint meeting (5 May 2019, Washington, DC, USA). This study was approved by the University of Calgary Conjoint Health Research Ethics Board (Ethics ID no. REB19-0321).
Recruitment and participation
We advertised the University of Calgary focus group participation through University of Calgary Graduate Students Association’s newsletter (n = 6500 subscribers), hard copies and electronic posters on University campus. Advertisement for OSSD focus group participation involved two emails, separated by one week, inviting all trainees registered to attend the general meeting (n = 152) and to the Canadian Institutes of Health Research’s Institute of Gender and Health national Sex and Gender Trainee Network (n = 50) (Fig. 1). Informed consent was obtained from all participants. Following data analysis from these two focus groups, recruitment expansion was deemed unnecessary, as we identified several recurring patterns in the data (barriers and recommendations presented by participants) with no new themes emerging (O’Reilly, 2012).
Data collection
After a 10-min presentation to give an overview on the definitions of sex and gender, focus groups were utilized to explore trainee experiences with incorporation of sex and gender-based considerations into health research. A priori, we decided to analyze the data in aggregate only to ensure the anonymity of our participants given the small sample size and the open group concept of our data collection gatherings. Standardized questions were posed to focus groups and were pilot tested with 15 local stakeholders (12 graduate trainees, 2 clinical trainees, 1 laboratory manager) at the University of Calgary and refined based on their feedback. We posed questions about participants’ experiences with integrating sex and gender considerations in their research. We provided sheets of paper for participants to record their personal and group discussion answers to the following questions: (1) “What are the major barriers you face when it comes to incorporating sex and gender considerations into your research?”; (2) “What changes would help you incorporate sex and gender considerations into your research?”; and (3) “What else can be done to develop your ability to incorporate sex and gender considerations in your research?”.
Qualitative analysis
Following the pilot test, three researchers (CZK, JPL, SBA) analyzed the written responses from the University of Calgary workshop (n = 15) independently and in duplicate to identify prominent themes and amended questions and probes to ensure discussion of key themes at the OSSD focus group. Final data analysis involved two researchers (CZK and SBA) analyzing the responses independently and in duplicate to fracture the data using an open coding methodology to identify emerging themes without the use of software (Strauss, 2003). Coded quotes were organized by themes and subthemes. In order to achieve agreement, researchers compared open coding and developed a codebook of emerging themes. Each investigator analyzed the remaining data sheets independently using open, axial and selective coding to expand and collapse themes (Strauss, 2003).
Results
Email invitations were sent to 202 individuals and an estimated 6500 individuals had access to electronic and paper copy recruitment posters. Fifty-three individuals attended the two focus groups. Two-thirds were self-identified women (62%) (Table 1). The majority of participants were graduate students (58%) or post-doctoral trainees (26%) and approximately three quarters were involved in biomedical (55%) and clinical (17%) research. All allied research personnel self-identified as women and were involved in biomedical (33%) and clinical (67%) research.
Qualitative analysis demonstrated three overarching themes of perceived barriers to integrating sex and gender considerations in health research: (1) lack of knowledge and skill; (2) lack of applicability and feasibility; (3) lack of funding agency and institutional culture. The themes were strongly entrenched in participant responses and categorized by subthemes to capture the variety of participant perspectives. Exemplar quotations are illustrated in Table 2.
Overarching themes
Lack of knowledge and skill
Lack of knowledge and skill was a dominant theme among participants. We define knowledge as the theoretical or practical understanding of a subject, and skill as abilities acquired through experience (e.g., critical appraisal of performing research) or education (e.g., seminars or courses). Participants described they lacked an approach to critically appraise existing research with a sex and gender lens. Subthemes included an inability to apply sex and gender-based analysis to qualitative analysis and limited literature that included more than one sex or gender.
Lack of applicability and feasibility
A perceived lack of applicability and feasibility of sex and gender in health research was the second theme that emerged in participant groups. We define applicability as the quality of being relevant or appropriate, while feasibility refers to the facility and practicality of incorporating sex and gender-based considerations. Due to the nature of some animal models used in health research (e.g., hermaphroditic or asexual organisms), some participants did not feel integrating sex and gender-based considerations was necessary or even relevant to their research. A prevalent subtheme was the notion that incorporation of sex considerations into research was not feasible given that more resources would be needed to accommodate a larger sample size that contains both males and females, particularly in animal studies. Participants also reported difficulty in understanding how to quantify and measure gender.
Institutional culture and lack of funding agency
Institutional culture and lack of funding support for sex and gender considerations in research were perceived to be important barriers among participants. We define institutional culture as the norms, beliefs, and values that influence processes and protocols within health research in an academic setting. We define funding agencies as any external organization, public or private, which undertakes a contractual agreement with a university to sponsor research. Participants described that in order to incorporate sex and gender considerations into research, additional resources such as animal care, space allotment, and increased sample size would be necessary; however, these additional required resources were not perceived by participants to be priorities for funders or institutions. A prominent subtheme highlighted by participants was the lack of support for incorporation of sex and gender-based considerations from primary supervisors.
Suggestions to improve incorporation of sex and gender considerations in health research
Participants were asked to offer solutions to improve the incorporation of sex and gender considerations into health research (Table 3). The following were the most common recommendations provided by participants:
The first, increase the awareness and development of SGBA skills in order to have widespread acceptance and consistent incorporation of SGBA into health research. Some participants described feeling limited by the capacity of their mentors in this domain, who may be cognizant of sex and gender considerations in research but lacked confidence accessing relevant resources or expertise.
Next, implement practical education curricula to facilitate understanding and provide methodological framework for incorporation of sex and gender-based considerations. Participants believed that academic institutions should be at the forefront of providing practical guidance in this area. Participants stated that courses at all levels (undergraduate, graduate, and medical school) in fields such as biostatistics and epidemiology should include SGBA as part of the syllabus. Participants described the importance of strong foundational knowledge of sex and gender considerations, starting with the ability to accurately define the terms “sex” and “gender” which are often erroneously used interchangeably, and educating researchers on the appropriate incorporation of sex and gender considerations where relevant, from study design through to publication and knowledge translation.
Lastly, encourage greater transparency and accountability by the research community. Commonly referred to as “change agents”, participants described how funding agencies and journal editors may be harnessed to encourage incorporation of sex and gender in research. Participants described that funding agencies could play a greater role in ensuring appropriate incorporation of sex and gender-based considerations, and that journal Editorial Boards should make it mandatory for investigators to report this information and require that at minimum, data be disaggregated by sex.
Interpretation
While there is increasing global recognition of the importance of considering sex and gender differences in health research (Del Boca, 2016; Hankivsky et al., 2018; Wald and Wu, 2010), little is known about the experiences and perspectives of scientists in the formative years of training or allied research personnel. Our study provides a qualitative investigation of trainee and allied study personnel perceptions on why sex and gender considerations are not consistently incorporated into health research and suggestions on how to improve. The detailed description of scientists-in-training presented here adds to the existing literature on sex and gender-based incorporation that has been developed using quantitative and qualitative methods (Hankivsky et al., 2018; Norris et al., 2019; Ramirez et al., 2017; Tannenbaum et al., 2017). This study identified three overarching themes representing perceived barriers, including the lack of knowledge and skill, lack of perceived applicability and feasibility, and lack of funding agency and institutional culture. Participants highlighted the need for increased awareness of sex and gender considerations in health research, implementation of educational curricula on sex and gender considerations, and greater transparency and accountability by funding organizations and journal editors of the importance of sex and gender in research.
Lack of knowledge and skill
The integration of sex and gender considerations into health research has the potential to encourage new perspectives, pose new questions and improve social equity to make the results of research more inclusive (Avery and Clark, 2016; Hankivsky et al., 2018; Heidari and Bachelet, 2018; Regensteiner et al., 2019; Tannenbaum et al., 2019). A lack of awareness and knowledge of sex and gender-based considerations has resulted in health research that has historically focused on male populations (Bartz et al., 2020), with the results of these studies being used to inform diagnosis and treatment of health conditions for the general population, and at times to the detriment of understudied groups (Santema et al., 2019). Among the 10 prescription pharmaceuticals withdrawn from the US market between 1997 and 2001, eight caused greater harm to women than men (U.S. Goverment Accountability Office G.-.-R, 2001). Previous research has highlighted that the terms “sex” and “gender” are often erroneously used interchangeably (Hammarstrom and Annandale, 2012). However, interactive online learning, combined with feedback and self-assessment, has been shown to result in improved knowledge and self-efficacy (Tannenbaum and van Hoof, 2018). This underscores the effectiveness of teaching methods to incorporate sex and gender considerations into health research.
Lack of applicability and feasibility
While participants involved in biomedical research described an appreciation for the importance of sex and gender considerations in research involving human participants, they did not feel SGBA was applicable or even relevant to preclinical models (e.g., hermaphroditic or asexual organisms). It is important to note that sex and gender factors still play important roles in many of these models (Koene, 2016). For example, the sex-ratio hypothesis suggests that hermaphroditic organisms assess the relative fitness payoffs for each sexual role, and thus the incentive to perform a specific sex role is flexible (Anthes et al., 2006). Many species of fish and reptiles demonstrate temperature-dependent sex determination (Conover and Kynard, 1981; Honeycutt et al., 2019; Ospina-Alvarez and Piferrer, 2008), a finding that may have implications for humans (Fukuda et al., 2014). Unfortunately, a lack of perceived applicability leads to a lack of reporting inclusive of sex and gender-related variables, limiting reproducibility and generalizability (Sugimoto et al., 2019). Participants also described a prevalent subtheme that in order to incorporate SGBA in research, the sample size must be doubled; therefore, requiring more funding and resources to accommodate a larger sample size. Using conventional single-factor design, there would indeed be a need for duplication of sample size; however, using a (balanced) factorial design offers the possibility of analyzing the impact of more than one categorical variable on the primary outcome (Buch et al., 2019; Dayton et al., 2016). Factorial design is an efficient experimental design (Festing, 1992, 1994) that would allow the gathering of sex-specific information while only modestly increasing sample size (Buch et al., 2019; Miller et al., 2017). Others have called for mixed cohorts without increasing sample size as a first step to determining if sex differences exist in mouse research models (Shansky, 2019).
Lack of funding agency and institutional culture
Participants highlighted the important role funders and academic institutions play in the incorporation of sex and gender considerations in health research. As of 2010, the Canadian Institutes of Health Research (CIHR) required that grant and graduate award applications indicate how sex and gender have been incorporated into the research project (Health Canada, 2009). In 1993, the United States Congress passed the National Institutes of Health (NIH) Revitalization Act to mandate inclusion of women as participants in clinical research (National Institute of Health), and since 2016 the NIH has required investigators to account for sex as a biological variable in all NIH-funded research (National Institutes of Health, 2015). The European Commission’s Horizon 2020 research program (Directorate-General for Research and Innovation, 2016) has made similar requirements for sex and gender incorporation, and a growing number of other funding agencies are increasingly supporting SGBA in research (Schiebinger et al., 2020). While a growing list of medical journals are adopting the Sex and Gender Equity in Research (SAGER) guidelines, the incorporation of sex and gender considerations in research remains insufficient (Heidari and Bachelet, 2018).
One of the key mechanisms for change in an organizational culture is to model the leader (Schein, 1990). As such, targeted education to senior leaders in health and science-related faculties may prove to be an effective method to influencing institutional approaches to incorporating sex and gender considerations into research. Publications with female first and last authors have an increased probability of sex-related reporting (Sugimoto et al., 2019); increasing gender diversity in the scientific workforce may thus contribute to greater incorporation of sex and gender considerations in health research.
Limitations
First, our study sample was limited; however, recruitment material was sent to almost 7000 potential participants. In addition, some participants may have been motivated to participate as a result of a previous positive or negative experience related to the incorporation of sex and gender in health research and thus some perspectives may have been missed. Next, the majority of comments reflect the perspective of trainees involved in biomedical research and thus our results may not accurately reflect those who are doing more participant-centered research. Furthermore, given the nature of our study design, whereby participants demographics were separate from their comments for the purposes of protecting anonymity, we were unable to stratify our data by the sex, gender, discipline, career stage (i.e. research personnel or trainee) or by geographical region (i.e. US, Canada, or Europe). Nevertheless, given the scope of our sample (i.e., perspectives from trainees and allied research personnel from the US, Canada, and Europe) and the distinct similarities of reported perceived barriers and recommendations across pillars of research, we believe that our results are worthy of consideration by all academic institutions. Finally, while we did not quantify the themes that emerged in the coding, we followed a rigorous approach consistent with qualitative research standards (Strauss, 2003) wherein the goal is theoretical (i.e., developing in-depth insight) not statistical (i.e., inferring the results from a sample to the broader population) generalizability. As qualitative research involves the collection, analysis, and interpretation of data that are not easily reduced to numbers and to quantify themes or emphasize how many people noted each particular theme is not largely accepted as an indicator of rigor in qualitative data. As such, we refrained from taking this approach and instead focused on identifying emergent and prominent themes across the dataset as opposed to measuring the appearance of thematic concepts.
Conclusion
To ensure the success of precision medicine, incorporation of sex and gender-based factors into all aspects of health research is essential. Despite the increased attention on sex and gender considerations in health research, it is clear that trainees and allied research personnel perceive barriers to its implementation. Addressing these barriers requires a multipronged approach through the action of institutions, funding organizations and journal editors to increase awareness, implement sex and gender methodology into education curricula and require greater transparency by researchers. Creating opportunities for scientists-in-training to integrate sex and gender considerations into their work will ultimately result in excellence in health research and better outcomes for all.
Data availability
All data generated or analyzed during this study was included in this published article.
Change history
24 February 2022
A Correction to this paper has been published: https://doi.org/10.1057/s41599-022-01085-9
References
Ahmed SB, Dumanski SM (2020). Sex, gender and COVID-19: a call to action. Can J Public Health (2020). https://doi-org.ezproxy.lib.ucalgary.ca/10.17269/s41997-020-00417-z.
Andrew N (2013) Clinical imprinting: the impact of early clinical learning on career long professional development in nursing. Nurse Educ Pract 13(3):161–164. https://doi.org/10.1016/j.nepr.2012.08.008
Anthes N, Putz A, Michiels NK (2006) Sex role preferences, gender conflict and sperm trading in simultaneous hermaphrodites: a new framework. Animal Behav 72(1):1–12
Avery E, Clark J (2016) Sex-related reporting in randomised controlled trials in medical journals. Lancet 388(10062):2839–2840. https://doi.org/10.1016/S0140-6736(16)32393-5
Bartz D, Chitnis T, Kaiser UB, Rich-Edwards JW, Rexrode KM, Pennell PB, … Manson J E (2020). Clinical advances in sex- and gender-informed medicine to improve the health of all: a review. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2019.7194
Berger JS, Roncaglioni MC, Avanzini F, Pangrazzi I, Tognoni G, Brown DL (2006) Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA 295(3):306–313. https://doi.org/10.1001/jama.295.3.306
Buch T, Moos K, Ferreira FM, Frohlich H, Gebhard C, Tresch A (2019) Benefits of a factorial design focusing on inclusion of female and male animals in one experiment. J Mol Med 97(6):871–877. https://doi.org/10.1007/s00109-019-01774-0
Collins FS, Varmus H (2015) A new initiative on precision medicine. N Engl J Med 372(9):793–795. https://doi.org/10.1056/NEJMp1500523
Conover DO, Kynard BE (1981) Environmental sex determination: interaction of temperature and genotype in a fish. Science 213(4507):577–579. https://doi.org/10.1126/science.213.4507.577
Dayton A, Exner EC, Bukowy JD, Stodola TJ, Kurth T, Skelton M, Cowley Jr AW (2016) Breaking the cycle: estrous variation does not require increased sample size in the study of female rats. Hypertension 68(5):1139–1144. https://doi.org/10.1161/HYPERTENSIONAHA.116.08207
de la Vega R, Ruíz-Barquín R, Boros S, Szabo A (2020) . Could attitudes toward COVID-19 in Spain render men more vulnerable than women? Global Public Health 15(9):1278–1291
Del Boca FK (2016) Addressing sex and gender inequities in scientific research and publishing. Addiction 111(8):1323–1325. https://doi.org/10.1111/add.13269
Directorate-General for Research & Innovation (2016). H2020 programme: guidance on gender equality in Horizon 2020. European Commission
Festing MF (1992) The scope for improving the design of laboratory animal experiments. Lab Anim 26(4):256–268. https://doi.org/10.1258/002367792780745788
Festing MF (1994) Reduction of animal use: experimental design and quality of experiments. Lab Anim 28(3):212–221. https://doi.org/10.1258/002367794780681697
Fukuda M, Fukuda K, Shimizu T, Nobunaga M, Mamsen LS, Yding Andersen C (2014) Climate change is associated with male:female ratios of fetal deaths and newborn infants in Japan. Fertil Steril 102(5):1364–1370 e1362. https://doi.org/10.1016/j.fertnstert.2014.07.1213
Global Health 5050 (2020). COVID-19 sex-disaggregated data tracker. http://globalhealth5050.org/covid19
Hamel L, Salganicoff A (2020). Is there a widening gender gap in coronavirus stress? https://www.kff.org/policy-watch/is-there-widening-gender-gap-in-coronavirus-stress/
Hammarstrom A, Annandale E (2012) A conceptual muddle: an empirical analysis of the use of ‘sex’ and ‘gender’ in ‘gender-specific medicine’ journals. PLoS ONE 7(4):e34193. https://doi.org/10.1371/journal.pone.0034193
Hankivsky O, Springer KW, Hunting G (2018) Beyond sex and gender difference in funding and reporting of health research. Res Integr Peer Rev 3:6. https://doi.org/10.1186/s41073-018-0050-6
Health Canada (2009). Health portfolio sex and gender-based analysis policy. https://www.canada.ca/en/health-canada/corporate/transparency/corporate-management-reporting/heath-portfolio-sex-gender-based-analysis-policy.html
Heidari S, Bachelet VC (2018) Sex and gender analysis for better science and health equity. Lancet 392(10157):1500–1502. https://doi.org/10.1016/S0140-6736(18)32619-9
Honeycutt JL, Deck CA, Miller SC, Severance ME, Atkins EB, Luckenbach JA, Godwin J (2019) Warmer waters masculinize wild populations of a fish with temperature-dependent sex determination. Sci Rep 9(1):6527. https://doi.org/10.1038/s41598-019-42944-x
Johnson HD, Sholcosky D, Gabello K, Ragni R, Ogonosky N (2003) Sex differences in public restroom handwashing behavior associated with visual behavior prompts. Percept Mot Skills 97(3 Pt 1):805–810. https://doi.org/10.2466/pms.2003.97.3.805
Koene JM (2016) Sex determination and gender expression: Reproductive investment in snails. Mol Reprod Dev 84(2):132–143
Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, Suzuki A (2020) Sex and gender: modifiers of health, disease, and medicine. Lancet 396(10250):565–582. https://doi.org/10.1016/S0140-6736(20)31561-0
Miller LR, Marks C, Becker JB, Hurn PD, Chen WJ, Woodruff T, Clayton JA (2017) Considering sex as a biological variable in preclinical research. FASEB J 31(1):29–34. https://doi.org/10.1096/fj.201600781R
Murray KB, Haubl G (2007) Explaining cognitive lock-in: the role of skill-based habits of use in consumer choice. J Consum Res 34:77–88
National Institute of Health. Including women and minorities in clinical research background. https://orwh.od.nih.gov/research/clinical-research-trials/nih-inclusion-policy/including-women-and-minorities-clinical
National Institutes of Health (2015). Considerationof sex as a biological variable in NIH-funded research. https://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-102.html
Norris CM, Tannenbaum C, Pilote L, Wong G, Cantor WJ, McMurtry MS (2019) Systematic incorporation of sex-specific information into clinical practice guidelines for the management of st-segment-elevation myocardial infarction: feasibility and outcomes. J Am Heart Assoc 8(7):e011597. https://doi.org/10.1161/JAHA.118.011597
O’Reilly MPN (2012) ‘Unsatisfactory Saturation’: a critical exploration of the notion of saturated sample sizes in qualitative research. Qual Res 13:190–197
Opotowsky AR, McWilliams JM, Cannon CP (2007) Gender differences in aspirin use among adults with coronary heart disease in the United States. J Gen Intern Med 22(1):55–61. https://doi.org/10.1007/s11606-007-0116-5
Ospina-Alvarez N, Piferrer F (2008) Temperature-dependent sex determination in fish revisited: prevalence, a single sex ratio response pattern, and possible effects of climate change. PLoS ONE 3(7):e2837. https://doi.org/10.1371/journal.pone.0002837
Ramirez FD, Motazedian P, Jung RG, Di Santo P, MacDonald Z, Simard T, Hibbert B (2017) Sex bias is increasingly prevalent in preclinical cardiovascular research: implications for translational medicine and health equity for women: a systematic assessment of leading cardiovascular journals over a 10-year period. Circulation 135(6):625–626. https://doi.org/10.1161/CIRCULATIONAHA.116.026668
Regensteiner JG, Libby AM, Huxley R, Clayton JA (2019) Integrating sex and gender considerations in research: educating the scientific workforce. Lancet Diabetes Endocrinol 7(4):248–250. https://doi.org/10.1016/S2213-8587(19)30038-5
Santema BT, Ouwerkerk W, Tromp J, Sama IE, Ravera A, Regitz-Zagrosek V, Voors AA (2019) Identifying optimal doses of heart failure medications in men compared with women: a prospective, observational, cohort study. Lancet 394(10205):1254–1263. https://doi.org/10.1016/S0140-6736(19)31792-1
Schein, E. H. (1990). Organizational culture. American Psychologist, 45(2), 109–119. https://doi.org/10.1037/0003-066X.45.2.109.
Schiebinger L, Klinge I, Madariaga ISD, Paik HY, Schraudner M, Stefanick M (2020). Sex and gender analysis policies of major granting agencies. http://genderedinnovations.stanford.edu/sex-and-gender-analysis-policies-major-granting-agencies.html
Schurz H, Salie M, Tromp G, Hoal EG, Kinnear CJ, Moller M (2019) The X chromosome and sex-specific effects in infectious disease susceptibility. Hum Genom 13(1):2. https://doi.org/10.1186/s40246-018-0185-z
Shansky RM (2019) Are hormones a “female problem” for animal research? Science 364(6443):825–826. https://doi.org/10.1126/science.aaw7570
Song W, Furco A, Maruyama G, Lopez I (2018) Early exposure to service- learning and college success beyond the freshman year. Int J Res Serv-Learn Community Engagem 6(1):Article 15
Strauss AL (2003) Qualitative analysis for social scientists. Cambridge University Press, Cambridge
Sugimoto CR, Ahn Y-Y, Smith E, Macaluso B, Larivière V (2019) Factors affecting sex-related reporting in medical research: a cross-disciplinary bibliometric analysis. Lancet 393(10171):550–559. https://doi.org/10.1016/S0140-6736(18)32995-7
Tannenbaum C, Clow B, Haworth-Brockman M, Voss P (2017) Sex and gender considerations in Canadian clinical practice guidelines: a systematic review. CMAJ Open 5(1):E66–E73. https://doi.org/10.9778/cmajo.20160051
Tannenbaum C, Ellis RP, Eyssel F, Zou J, Schiebinger L (2019) Sex and gender analysis improves science and engineering. Nature 575(7781):137–146. https://doi.org/10.1038/s41586-019-1657-6
Tannenbaum C, van Hoof K (2018) Effectiveness of online learning on health researcher capacity to appropriately integrate sex, gender, or both in grant proposals. Biol Sex Differ 9(1):39. https://doi.org/10.1186/s13293-018-0197-3
U.S. Goverment Accountability Office-01-286R. (2001). Drug safety: most drugs withdrawn in recent years had greater health risks for women. https://www.gao.gov/products/gao-01-286r
Wald C, Wu C (2010) Biomedical research. Of mice and women: the bias in animal models. Science 327(5973):1571–1572. https://doi.org/10.1126/science.327.5973.1571
Acknowledgements
This work was supported in part by the Canadian Institutes of Health Research Institute of Gender and Health and the Libin Cardiovascular Institute, University of Calgary.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Kalenga, C.Z., Parsons Leigh, J., Griffith, J. et al. Sex and gender considerations in health research: a trainee and allied research personnel perspective. Humanit Soc Sci Commun 7, 152 (2020). https://doi.org/10.1057/s41599-020-00643-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1057/s41599-020-00643-3
- Springer Nature Limited