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Table 1 Relevance of four gender constructs to implementation research and practice

From: Why sex and gender matter in implementation research

Gender construct Definition Examples of potential questions for implementation research Examples of potential questions for implementation practice Examples of measures
Gender roles [6, 28] Represent the behavioral norms applied to men and women in society, which influence individuals’ everyday actions, expectations, and experiences. Gender roles often categorize and define individuals within the family, the labour force, or the educational system. May form the basis for stereotypes. How can considering gender roles help us understand and anticipate barriers and opportunities facing health-care professionals in the uptake of new interventions? How can considering gender roles help inform dissemination strategies that are successful in reaching different audiences where they are? The Gender Role Conflict Index [73]
Other variables such as occupation [45], primary breadwinner status, time doing household chores and caregiving responsibilities can also be used to capture gender roles in data collection and analysis [46].
Gender identity [6, 28, 32, 39, 40, 42] Describes how we see ourselves, and are seen by others, as female or male, or across a feminine-masculine continuum. Individuals may also self-identify dynamically along the continuum of gender-queer and/or transgender. Gender identity affects our feelings and behaviors. Do a range of gender identities need to be considered when asking the question, “for whom does this implementation strategy work and under which circumstances?” Will the reach of the implementation intervention extend to male, female and transgender individuals? The BEM sex role inventory [74]
The Personal Attributes Questionnaire [75]
Should the content of the implementation intervention consider gender identity or sexual orientation? The Conformity to Masculine Norms Inventory [76],
A two-step approach to measuring gender identity first asks individuals to indicate their sex assigned at birth (male/female), and then asks the same individuals how they currently self-identify (male, female, trans male/trans man, trans female/trans woman, gender queer/gender non-conforming) [39, 40].
Gender relations [6, 28, 33] Refers to how we interact with or are treated by people in the world around us, based on our ascribed or experienced gender. How might the outcomes of implementation interventions differ by sex and gender according to whether the degree to which the geographic setting is culturally homogeneous, diverse or gender equitable? What are the implications of an implementation intervention being communicated or delivered to women only, men only, men and women separately or together? How is this mediated by cultural context? The Self-Perceived and Self-Reported Gender Equality scale [77].
Institutionalized gender [6, 28, 33] Reflects the distribution of power between men and women in the political, educational, and social institutions in society. The institutionalized aspect of gender also shapes social norms that define, reproduce, and often justify different expectations and opportunities for men and women. If particular decision-maker groups value, use, or require, different kinds of knowledge, have you considered how institutionalized gender might play a role? How might this change over time? How can dissemination messages be crafted in a way that responds to sex and gender–related factors without reproducing or exploiting any negative stereotypes embedded in institutionalized gender? The use of qualitative methods (e.g. case studies, ethnography, narrative and descriptive qualitative approaches etc.) can be used to explore concepts of institutionalized gender, and to gain a more in-depth understanding of gender as a barrier or enabler.