Measurement of gender as a social construct in quantitative health research – a critical review

Abstract

Abstract Background The relevance of gender as a social determinant of health inequalities is now broadly acknowledged. However, the plethora of existing approaches to capture gender, which are often stemming from disciplines outside of public health, makes it difficult to assess their practicality and relevance for a given research purpose. We conducted a critical review to 1) map the evidence of how gender can be operationalised in quantitative health research and 2) critically evaluate the identified measures. Methods We identified peer-reviewed articles in electronic databases (PubMed, Embase and PsycINFO), as well as grey literature in OpenGrey and on the website of governmental and not-for-profit organisations that actively encourage gender-sensitive public health research. Eligible sources described the quantitative operationalisation of the social dimension of gender. With the help of a newly developed scorecard, we assessed their relevance from a theory perspective (e.g. intersectionality) and the potential for implementation from a practical, epidemiological point of view. Results Gender measures principally assessed gender roles, gender-based discrimination and gender (in)equality. The majority lacked theoretical foundation, and tended to reinforce the binary understanding of gender identity through stereotypes of femininity and masculinity. An intersectional approach was found mostly in data-driven composite measures. Those also had the advantage of being easy to construct with standard health monitoring data. Conclusions A range of gender measures are readily available for public health research, addressing different levels and dimensions of gender as a social construct. With our theory-informed, practice-driven critical review, we highlighted their strengths and limitations and provided analytical tools for researchers interested in conducting intersectional gender-sensitive analyses. Key messages Gender and its impact on health can be captured through a range of measures (e.g. scales, indices). Among those, non-binary, theory-informed understandings of gender remain underrepresented. With the help of a newly developed scorecard, our critical review highlights the various gender measures’ strengths and limitations from a theory perspective and a practical point of view.