Integration of sex and gender in a continuing professional development course on diabetes and depression: a mixed methods feasibility study

Alèxe Deom Tardif, Amédé Gogovor, Sabrina Guay-Bélanger, Denis Audet, Nicole Parent, André Gaudreau, Danièle Remy-Lamarche, Luc Vigneault, Gérard Ngueta, André Bilodeau, France Légaré, mATrICES-F Group, Alèxe Deom Tardif, Amédé Gogovor, André Bilodeau, André Bussières, André Gaudreau, Audrey Ferron Parayre, Caroline Jose, Danièle Remy-Lamarche, Dawn Stacey, Denis Audet, Denis Prud'homme, France Légaré, Francine Borduas, Gerard Ngueta, Hélène Lee-Gosselin, Isabelle Auclair, Laurie Laplanche, Luc Vigneault, Maman Joyce Dogba, Marie-Claude Tremblay, Marie-Pierre Gagnon, Nicole Parent, Sabrina Guay-Bélanger, Sophie Desroches, Valérie Borde, Geneviève Roch, Alèxe Deom Tardif, Amédé Gogovor, Sabrina Guay-Bélanger, Denis Audet, Nicole Parent, André Gaudreau, Danièle Remy-Lamarche, Luc Vigneault, Gérard Ngueta, André Bilodeau, France Légaré, mATrICES-F Group, Alèxe Deom Tardif, Amédé Gogovor, André Bilodeau, André Bussières, André Gaudreau, Audrey Ferron Parayre, Caroline Jose, Danièle Remy-Lamarche, Dawn Stacey, Denis Audet, Denis Prud'homme, France Légaré, Francine Borduas, Gerard Ngueta, Hélène Lee-Gosselin, Isabelle Auclair, Laurie Laplanche, Luc Vigneault, Maman Joyce Dogba, Marie-Claude Tremblay, Marie-Pierre Gagnon, Nicole Parent, Sabrina Guay-Bélanger, Sophie Desroches, Valérie Borde, Geneviève Roch

Abstract

Objectives: Assess the feasibility and impact of a continuous professional development (CPD) course on type 2 diabetes and depression on health professionals' intention to include sex and gender considerations in patient care.

Design and setting: In collaboration with CPD organisations and patient-partners, we conducted a mixed-methods feasibility controlled trial with postintervention measures in three Canadian provinces.

Participants: Of 178 eligible health professionals, 127 completed questionnaires and 67 participated in semistructured group discussions.

Intervention and comparator: An interactive 1 hour CPD course, codesigned with patient-partners, on diabetes and depression that included sex and gender considerations (innovation) was compared with a similar course that did not include them (comparator).

Outcomes: Feasibility of recruitment and retention of CPD organisations and patient-partners throughout the study; adherence to planned activities; health professionals' intention to include sex and gender considerations in patient care as measured by the CPD-Reaction questionnaire; and barriers and facilitators using the Theoretical Domains Framework.

Results: All recruited CPD organisations and patient-partners remained engaged throughout the study. All planned CPD courses occurred. Overall, 71% of eligible health professionals participated (63% under 44 years old; 79.5% women; 67.7% practising in French; 66.9% practising in Quebec; 78.8% in urban practice). After training, mean intention scores for the innovation (n=49) and control groups (n=78) were 5.65±0.19 and 5.19±0.15, respectively. Mean difference was -0.47 (CI -0.95 to 0.01; p=0.06). Adjusted for age, gender and practice settings, mean difference was -0.57 (CI -1.09 to -0.05; p=0.03). We identified eight theoretical domains related to barriers and six related to facilitators for providing sex-adapted and gender-adapted diabetes and depression care.

Conclusions: CPD training on diabetes and depression that includes sex and gender considerations is feasible and, compared with CPD training that does not, may prompt health professionals to modify their care. Addressing identified barriers and facilitators could increase intention.

Trial registration number: NCT03928132 with ClinicalTrials.gov; Post-results.

Keywords: education & training (see medical education & training); primary care; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart of participants. *This is an approximate figure given the changing dynamics of the hospital’s professional environment; an email was sent to 2000 employees including healthcare professionals, others were invited using posters in the training sites, oral communication at a meeting with the organising team of the clinical setting, and announcements in Médecins francophones du Canada’s conference calendar. CPD, continuing professional development.

References

    1. Clayton JA, Tannenbaum C. Reporting sex, gender, or both in clinical research? JAMA 2016;316:1863. 10.1001/jama.2016.16405
    1. Institut de recherche en santé du Canada . Comment intégrer le sexe et le genre à la recherche, 2019. Available: [Accessed 2 March 2021].
    1. Johnson JL, Greaves L, Repta R. Better science with sex and gender: facilitating the use of a sex and gender-based analysis in health research. Int J Equity Health 2009;8:14. 10.1186/1475-9276-8-14
    1. Oliffe J, Greaves L. Designing and conducting gender, sex, and health research.. Thousand Oaks, California, 2012.
    1. Légaré F, Lee-Gosselin H, Borduas F, et al. . Approaches to considering sex and gender in continuous professional development for health and social care professionals: an emerging paradigm. Med Teach 2018;40:875–9. 10.1080/0142159X.2018.1483579
    1. Tannenbaum C, Ellis RP, Eyssel F, et al. . Sex and gender analysis improves science and engineering. Nature 2019;575:137–46. 10.1038/s41586-019-1657-6
    1. Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev 2016;37:278–316. 10.1210/er.2015-1137
    1. Geary N. Counterpoint: physiologists should not distinguish "sex" and "gender". Am J Physiol Regul Integr Comp Physiol 2010;298:R1702–4. 10.1152/ajpregu.00113.2010
    1. Demmer RT, Gelb S, Suglia SF, et al. . Sex differences in the association between depression, anxiety, and type 2 diabetes mellitus. Psychosom Med 2015;77:467–77. 10.1097/PSY.0000000000000169
    1. Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry 2017;4:146–58. 10.1016/S2215-0366(16)30263-2
    1. Turecki G, Brent DA. Suicide and suicidal behaviour. The Lancet 2016;387:1227–39. 10.1016/S0140-6736(15)00234-2
    1. Zhuang Q-S, Shen L, Ji H-F,. Quantitative assessment of the bidirectional relationships between diabetes and depression. Oncotarget 2017;8:23389–400. 10.18632/oncotarget.15051
    1. Ali S, Stone MA, Peters JL, et al. . The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006;23:1165–73. 10.1111/j.1464-5491.2006.01943.x
    1. Ahmad A, Abujbara M, Jaddou H, et al. . Anxiety and depression among adult patients with diabetic foot: prevalence and associated factors. J Clin Med Res 2018;10:411–8. 10.14740/jocmr3352w
    1. Toker S, Shirom A, Melamed S. Depression and the metabolic syndrome: gender-dependent associations. Depress Anxiety 2008;25:661–9. 10.1002/da.20379
    1. Möller-Leimkühler AM. Gender differences in cardiovascular disease and comorbid depression. Dialogues Clin Neurosci 2007;9:71–83. 10.31887/DCNS.2007.9.1/ammoeller
    1. Coen SBE. What a difference sex and gender make: a gender, sex and. Vancouver: Health Research Casebook, 2012.
    1. Gilbert-Ouimet M, Trudel X, Aubé K, et al. . Differences between women and men in the relationship between psychosocial stressors at work and work absence due to mental health problem. Occup Environ Med 2020;77:603–10. 10.1136/oemed-2019-106242
    1. Deischinger C, Dervic E, Leutner M, et al. . Diabetes mellitus is associated with a higher risk for major depressive disorder in women than in men. BMJ Open Diabetes Res Care 2020;8:e001430. 10.1136/bmjdrc-2020-001430
    1. Tannenbaum C, Greaves L, Graham ID. Why sex and gender matter in implementation research. BMC Med Res Methodol 2016;16:145. 10.1186/s12874-016-0247-7
    1. Tannenbaum C, Clow B, Haworth-Brockman M, et al. . Sex and gender considerations in Canadian clinical practice guidelines: a systematic review. CMAJ Open 2017;5:E66–73. 10.9778/cmajo.20160051
    1. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 2001;79:281–315. 10.1111/1468-0009.00206
    1. Davis D, et al. . The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003;327:33–5. 10.1136/bmj.327.7405.33
    1. Davis D, Galbraith R. Continuing medical education effect on practice performance. Chest 2009;135:42S–8. 10.1378/chest.08-2517
    1. Institute of Medicine . Redesigning continuing education in the health professions. Washington, DC: The National Academies Press, 2010: 296.
    1. Godin G. Les comportements dans le domaine de la santé : Comprendre pour mieux intervenir. Montréal, Québec: Les Presses de l'Université de Montréal, 2012.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991;50:179–211. 10.1016/0749-5978(91)90020-T
    1. Légaré F, Borduas F, Freitas A. User manual – the continuing professional development (CPD) reaction questionnaire, 2015.
    1. Atkins L, Francis J, Islam R, et al. . A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci 2017;12:77. 10.1186/s13012-017-0605-9
    1. Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 2012;7:37. 10.1186/1748-5908-7-37
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42. 10.1186/1748-5908-6-42
    1. Eldridge SM, Chan CL, Campbell MJ, et al. . Consort 2010 statement: extension to randomised pilot and feasibility trials. BMJ 2016;355:i5239. 10.1136/bmj.i5239
    1. Gogovor A, Mollayeva T, Etherington C, et al. . Sex and gender analysis in knowledge translation interventions: challenges and solutions. Health Res Policy Syst 2020;18:108. 10.1186/s12961-020-00625-6
    1. Atlantis E, Fahey P, Foster J. Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis. BMJ Open 2014;4:e004706. 10.1136/bmjopen-2013-004706
    1. Holt RIG, de Groot M, Golden SH. Diabetes and depression. Curr Diab Rep 2014;14:491. 10.1007/s11892-014-0491-3
    1. Harreiter J, Fadl H, Kautzky-Willer A, et al. . Do women with diabetes need more intensive action for cardiovascular reduction than men with diabetes? Curr Diab Rep 2020;20:61. 10.1007/s11892-020-01348-2
    1. Légaré F, Freitas A, Turcotte S, et al. . Responsiveness of a simple tool for assessing change in behavioral intention after continuing professional development activities. PLoS One 2017;12:e0176678. 10.1371/journal.pone.0176678
    1. Légaré F, Borduas F, Freitas A, et al. . Development of a simple 12-Item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions. PLoS One 2014;9:e91013. 10.1371/journal.pone.0091013
    1. Godin G, Bélanger-Gravel A, Eccles M, et al. . Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci 2008;3:36. 10.1186/1748-5908-3-36
    1. Michie S, Johnston M, Abraham C, et al. . Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005;14:26–33. 10.1136/qshc.2004.011155
    1. Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–37. 10.1093/oxfordjournals.aje.a115101
    1. Budtz-Jørgensen E, Keiding N, Grandjean P, et al. . Confounder selection in environmental epidemiology: assessment of health effects of prenatal mercury exposure. Ann Epidemiol 2007;17:27–35. 10.1016/j.annepidem.2006.05.007
    1. O'Cathain A, Murphy E, Nicholl J. Three techniques for integrating data in mixed methods studies. BMJ 2010;341:c4587. 10.1136/bmj.c4587
    1. Michie S, Atkins L RW. The behaviour change wheel : a guide to designing Interventions. Great Britain: Silverback Publishing, 2014.
    1. West R, Michie S. A brief introduction to the COM-B model of behaviour and the prime theory of motivation. Qeios 2020. 10.32388/WW04E6.2
    1. Agbadjé TT, Menear M, Dugas M, et al. . Pregnant women's views on how to promote the use of a decision aid for Down syndrome prenatal screening: a theory-informed qualitative study. BMC Health Serv Res 2018;18:434. 10.1186/s12913-018-3244-1
    1. Garvelink MM, Freitas A, Menear M, et al. . In for a Penny, in for a pound: the effect of pre-engaging healthcare organizations on their subsequent participation in trials. BMC Res Notes 2015;8:751. 10.1186/s13104-015-1743-2
    1. Little P, Hayes S. Continuing professional development (CPD): GPs’ perceptions of post-graduate education-approved (PGEA) meetings and personal professional development plans (PDPs). Fam Pract 2003;20:192–8. 10.1093/fampra/20.2.192
    1. Veloshnee G, Loveday P-K. Gender biases and discrimination: a review of health care interpersonal interactions, 2007. Available:
    1. Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, et al. . Sex and gender: modifiers of health, disease, and medicine. The Lancet 2020;396:565–82. 10.1016/S0140-6736(20)31561-0
    1. Bairey Merz CN, Andersen H, Sprague E, et al. . Knowledge, Attitudes, and Beliefs Regarding Cardiovascular Disease in Women: The Women's Heart Alliance. J Am Coll Cardiol 2017;70:123–32. 10.1016/j.jacc.2017.05.024
    1. Kling JM, Rose SH, Kransdorf LN, et al. . Evaluation of sex- and gender-based medicine training in post-graduate medical education: a cross-sectional survey study. Biol Sex Differ 2016;7:38. 10.1186/s13293-016-0097-3
    1. Curran VR, Fleet L, Kirby F. Factors influencing rural health care professionals' access to continuing professional education. Aust J Rural Health 2006;14:51–5. 10.1111/j.1440-1584.2006.00763.x
    1. Berndt A, Murray CM, Kennedy K, et al. . Effectiveness of distance learning strategies for continuing professional development (CPD) for rural allied health practitioners: a systematic review. BMC Med Educ 2017;17:117. 10.1186/s12909-017-0949-5
    1. OECD . Geographic variations in health care: what do we know and what can be done to improve health system performance? Paris: OECD Publishing, 2014. 10.1787/9789264216594-en
    1. Bertakis KD, Helms LJ, Callahan EJ, et al. . The influence of gender on physician practice style. Med Care 1995;33:407–16. 10.1097/00005650-199504000-00007
    1. Carey RN, Connell LE, Johnston M, et al. . Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Annals of Behavioral Medicine 2018;384:693–707. 10.1093/abm/kay078
    1. Etherington C, Rodrigues IB, Giangregorio L, et al. . Applying an intersectionality lens to the theoretical domains framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour. BMC Med Res Methodol 2020;20:169. 10.1186/s12874-020-01056-1
    1. Guly HR. Continuing professional development for doctors in accident and emergency. J Accid Emerg Med 2000;17:12–14. 10.1136/emj.17.1.12
    1. Peek ME. Gender differences in diabetes-related lower extremity amputations. Clin Orthop Relat Res 2011;469:1951–5. 10.1007/s11999-010-1735-4
    1. Weziak-Bialowolska D. Differences in gender norms between countries: are they valid? the issue of measurement invariance. Eur J Popul 2015;31:51–76. 10.1007/s10680-014-9329-6
    1. MacDermid JC, Graham ID. Knowledge translation: putting the "practice" in evidence-based practice. Hand Clin 2009;25:125–43. 10.1016/j.hcl.2008.10.003
    1. Eccles MP, Hrisos S, Francis J, et al. . Do self- reported intentions predict clinicians' behaviour: a systematic review. Implement Sci 2006;1:28. 10.1186/1748-5908-1-28
    1. Wakefield J, Herbert CP, Maclure M, et al. . Commitment to change statements can predict actual change in practice. J Contin Educ Health Prof 2003;23:81–93. 10.1002/chp.1340230205
    1. van Braak M, Visser M, Holtrop M, et al. . What motivates general practitioners to change practice behaviour? A qualitative study of audit and feedback group sessions in Dutch general practice. BMJ Open 2019;9:e025286. 10.1136/bmjopen-2018-025286

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다