Studying gender in the experiences of patients with heart failure: A scoping review of qualitative studies and methodological recommendations

Abstract

Background: Considering how gendered experiences play a role in the lives of patients with heart failure (HF) is critical in order to understand their experiences, optimise clinical care and reduce health inequalities.

Objectives: The aim of our study was to review how gender is being studied in qualitative research in HF, specifically to (1) analyse how gender is conceptualised and applied in qualitative HF research; and (2) identify methodological opportunities to better understand the gendered experiences of patients with HF.

Eligibility criteria: We conducted a systematic search of literature, including qualitive or mixed-methods articles focussing on patients' perspectives in HF and using gender as a primary analytical factor, excluding articles published before 2000.

Sources of evidence: Our search returned 3121 records, which were independently screened by two authors, resolving disagreements through a consensus procedure.

Charting methods: Two reviewers extracted the characteristics of the included studies and methodological quality. We applied the Integrating Sex and Gender Checklist and gender theory as an analytical tool to synthesise results relating to the conceptualisation and application of gender in the included studies.

Results: We included 11 qualitative articles that used interviews (n = 10) or focus groups (n = 1) to investigate the role of gender in experiences of patients with HF. None of the included studies defined their conceptual approach to gender, or used gender-related theoretical frameworks. This led to results and conclusions which were drawn along binary lines - representing gender as two separate, oppositional and mutually exclusive categories, and paying little attention to the dynamic, relational and context-dependent aspects of gender.

Conclusions: Although researchers have investigated the role of gender in the experiences of patient with HF, methodological improvements are needed to prevent the current retelling of gender as a binary variable with two opposed and mutually exclusive categories. To better understand gendered experiences in HF, researchers need to avoid a reductionist and essentialist approach to gender. To this end, researchers should clearly state their conceptual approach to gender and analyse their findings using state-of-the-art gender theoretical frameworks and intersectional approaches. Ultimately, this will allow the development of tailored and effective clinical care.

Keywords: gender medicine; health equity; heart failure; intersectionality; patient experience; scoping review.

Figure 1.

Flowchart of the search and selection procedure of studies.