“Sex” and “Gender” in Research Reports in Nursing Journals

The current featured ANS article is titled “An Analysis of the Use of the Terms Sex and Gender in
Research Reported in Nursing Journals” authored by John R. Blakeman, PhD, RN, PCCN-K and Valentina M. Fillman, PhD, RN. This article is available to download at no cost while it is featured, and we welcome your discussion about the issues raised here on the blog! Dr. Blakeman shared the background related to this work here:

I learned a tremendous amount of information during my PhD coursework. I can still remember sitting in my Theoretical Basis of Nursing Research course, discussing the importance of defining variables precisely and transparently. My classmates and I agreed that if variables were imprecisely defined, operationalized, or reported, trusting the findings of a particular study is more difficult and muddies the science. It was during this time that I began to think more carefully about the common variables used in research reports. Certain fundamental demographic variables, such as sex and gender, are among the most used variables in all research reports.

At the time, many questions circled my mind, including (but not limited to):

• Do researchers carefully decide whether they will use sex, gender, or both as variables in their studies?
• How precisely are sex and gender defined and operationalized in nursing research?
• How much ambiguity exists in the way that sex and gender are described in research reports?
• Do researchers understand the difference between sex and gender?

Simultaneously, I was beginning to think about my dissertation study – what variables I would include and how I would define and operationalize these variables. Notably, my dissertation work focused on women’s experience of prodromal myocardial infarction symptoms – those symptoms that occur in the days, weeks, and months before myocardial infarction. Thus, it was especially important for me to think about what I truly meant by women’s experiences… Did I mean biologically female (at least as assigned at birth, based on genitalia)? Did I mean woman, as in a person who identified as a woman, even if their sex assigned at birth was not female? Or did I mean something else?

As a first step in answering the many questions that I had about sex and gender, I undertook a comprehensive literature review, ultimately penning an article titled “Words Matter: Sex and Gender as Unique Variables in Research,” also published in Advances in Nursing Science. This initial paper helped me focus my thinking regarding these two variables, and upon completion of my PhD, I decided to more fully explore how sex and gender were used in the research published in nursing journals.

I collaborated with Dr. Valentina Fillman to conduct the present study. She and I had long discussions about what research questions to include and how best to capture what was “happening” in the nursing literature. Ultimately, we decided that we needed to start at a basic level, given that limited information has been published about how sex and gender are specifically used/reported in research published in nursing journals. We felt that this initial work could point us in new directions moving forward – highlighting areas requiring additional focus or attention.

While I will let the article speak for itself, so to speak, the bottom line is that we found a large amount of ambiguity in the way that sex and gender were defined, used, and reported across the articles included in our study. It is important to note that in some cases it was difficult to know how authors defined or used sex and/or gender, given that reporting was limited. However, even when sex and/or gender were more clearly reported, issues of ambiguity or imprecision were common. In some cases, sex and gender were used interchangeably, and it was difficult to know which of these variables the authors truly measured.

Ultimately, the findings of this study led me to the conclusion that all researchers need to decide with more care a) whether they will use sex, gender, or both as variables in their research, b) how they will define and operationalize these variables, and c) how they will clearly report these variables. As researchers, I think that we sometimes become so focused on defining and measuring outcome variables that we take the demographic or independent variables in a study for granted. Perhaps these demographic variables have become so familiar that we do not give them additional thought. However, I hope that this paper serves to remind us all of the importance of carefully measuring and reporting sex and gender in research.