Sex and Gender: Investigating Cultural Competency in Health Education Literature

Significance: Cultural competency is necessary to close the disparities gap in health care. Cultural and linguistic competence is inextricably connected to the quality of care delivered, and is an important issue affecting all providers, including health educators. Traditionally, cultural competence has been related to racially- or ethnically-focused discussions. However, culture extends beyond these traditional categories. The seamless interchange of the terms sex and gender violates the premise of cultural and linguistic competence. Sex refers to the biological characteristics of a person at birth, while gender is a set of socially constructed roles, behaviors, and attributes. Failure to accurately use these terms reduces the quality of care and the value of research for a present, yet underrepresented culture. Purpose: To evaluate research-based health education articles for accurate usage of the terms sex and gender. Methods: All published research-based articles from January 2007 through April 2010 in Health Education and Behavior and the American Journal of Health Education were reviewed (n=287). Two independent researchers reviewed each article to determine if data regarding participant sex was collected, if results were presented as sex or gender data, and if discussion surrounding the results was based on the definition of sex or gender. Inter-rater reliability was determined for the collected data. Results: Of the 287 articles reviewed, researchers in approximately 65% of the studies collected sex data from participants. Of these studies, researchers accurately reported the sex data collected in only 26% of the results sections. Additionally, when discussing the results in context of the research conducted, researchers accurately utilized the terms sex and gender in relation to their data only 26% of the time. Initial Cohen's kappa coefficient for inter-rater reliability was .92. Incongruent data determinations were discussed and agreed upon prior to data analyses. Conclusions: A health educator's responsibility to understand and respect the values, attitudes, and beliefs of an intended population is crucial. Health educators need to be aware of their own cultural values as a means of recognizing how they influence attitudes, behaviors, interventions, and material development. Demonstration of cultural and linguistic competence within research publications is an important step for the improvement of health-care delivery for all cultures. Learner Objectives: At the conclusion of this presentation, participants will be able to: 1) accurately define sex and gender in relation to cultural competency; and 2) identify methods to enhance cultural competency of research in terms of sex and gender.