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Gender awareness in medicine: adaptation and validation of the Nijmegen Gender Awareness in Medicine Scale to the Portuguese population (N-GAMS)

  • Rita MoraisEmail author
  • Sónia F. Bernardes
  • Petra Verdonk
Article
  • 54 Downloads

Abstract

Health care professionals’ gender awareness has been presented as a mechanism to minimize gender biases in health. The present paper aimed to adapt and validate the Nijmegen Gender Awareness in Medicine Scale (N-GAMS, Verdonk et al. in Sex Roles 58:222–234, 2008.  https://doi.org/10.1007/s11199-007-9326-x) to the Portuguese population, also addressing some limitations of its original study, namely by: (1) testing the scale’s three-fold underlying structure and (2) extending the study of its criteria-related validity, by analyzing sex-related differences in medical students’ gender awareness and the associations between gender awareness and empathy and sexism. One thousand and forty-eight medical students (Mage = 22.90; 67.1% women) filled out the Portuguese version of the N-GAMS (N-GAMS.pt) along with measures of Physician Empathy and Sexism. A Parallel Analysis and an Exploratory Factor Analysis suggested the presence of three factors. A Confirmatory Factor Analysis showed a good fit of the hypothesized three-factor structure: (1) gender sensitivity (n = 6 items; α = .713), (2) gender-role ideologies towards patients (n = 7 items; α = .858) and (3) gender-role ideologies towards doctors (n = 5 items; α = .837), with a positive association between the latter two (r = .570; p < .001). The N-GAMS.pt also showed good criteria-related validity. Namely, as hypothesized: (1) more empathic students reported more gender sensitivity and lower endorsement of gender-role ideologies; (2) higher hostile and benevolent sexism were associated to higher endorsement of gender-role ideologies; and (3) higher hostile sexism was associated to lower gender sensitivity. Implications of the N-GAMS for research and interventional purposes are discussed.

Keywords

Gender awareness Gender sensitivity Empathy Sexism Scale development 

Notes

Acknowledgements

We would like to thank Cláudia Andrade and Andreia Ferreira for their help with the forward -backward translation of the N-GAMS items and instructions, and Marta Matos and Helena Carvalho for their statistical advice. This study was carried out following the ethical and deontological guidelines of ISCTE-Instituto Universitário de Lisboa (ISCTE-IUL) and the Portuguese Board of Psychologists (Ordem dos Psicólogos Portugueses, 2011).

Funding

This study was funded by a Ph.D. Grant by Fundação para a Ciência e Tecnologia (FCT/PD/BD/111187/2015) to Rita Morais, supervised by Sónia F. Bernardes and co-supervised by Petra Verdonk.

Compliance with ethical standards

Conflict of interest

There were no financial or other relationships that lead to conflicts of interest in the development of this piece of research.

Supplementary material

10459_2019_9936_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)

References

  1. Aguiar, P., Salgueira, A., Frada, T., & Costa M. J. (2009). Empatia Médica: tradução, validação e aplicação de um instrumento de medição. Actas do X Congresso Internacional Galego-Português de Psicopedagogia. Braga: Universidade do Minho.Google Scholar
  2. Anderson, S. J., & Johnson, J. T. (2003). The who and when “gender-blind” attitudes: Predictors of gender-role egalitarianism in two different domains. Sex Roles, 49, 527–532.  https://doi.org/10.1023/A:1025836807911.CrossRefGoogle Scholar
  3. Andersson, J., Verdonk, P., Johansson, E., Lagro-Janssen, T., & Hamberg, K. (2012). Comparing gender awareness in Dutch and Swedish first-year medical students: Results from a questionnaire. BMC Medical Education, 12(3), 1–10.  https://doi.org/10.1186/1472-6920-12-3.CrossRefGoogle Scholar
  4. Arbuckle, J. L. (2014). Amos (version 23.0) [computer program]. Chicago: IBM SPSS.Google Scholar
  5. Barreto, M., & Ellemers, N. (2005). The burden of benevolent sexism: How it contributes to the maintenance of gender inequalities. European Journal of Social Psychology, 35, 633–642.  https://doi.org/10.1002/ejsp.270.CrossRefGoogle Scholar
  6. Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25, 3186–3191.  https://doi.org/10.1097/00007632-200012150-00014.CrossRefGoogle Scholar
  7. Brewer, M. B. (1979). In-group bias in the minimal intergroup situation: A cognitive-motivational analysis. Psychological Bulletin, 86, 307–324.  https://doi.org/10.1037/0033-2909.86.2.307.CrossRefGoogle Scholar
  8. Cadinu, M. R., & Rothbart, M. (1996). Self-anchoring and differentiation processes in the minimal group setting. Journal of Personality and Social Psychology, 70(4), 661–677.  https://doi.org/10.1037/0022-3514.70.4.661.CrossRefGoogle Scholar
  9. Costa, P. A., Oliveira, R., Pereira, H., & Leal, I. (2015). Adaptação dos inventários de Sexismo Moderno para Portugal: o inventário de Sexismo Ambivalente e oinventário de Ambivalência em relação aos Homens. Psicologia Reflexão e Crítica, 28(1), 126–135.  https://doi.org/10.1590/1678-7153.201528114.CrossRefGoogle Scholar
  10. Cuddy, A. J. C., Fiske, S. T., & Glick, P. (2004). When professionals become mothers, warmth doesn’t cut the ice. Journal of Social Issues, 60, 701–718.  https://doi.org/10.1111/j.0022-4537.2004.00381.x.CrossRefGoogle Scholar
  11. Dielissen, P., Verdonk, P. M., Bottema, B., Kramer, A., & Lagro-Janssen, T. (2012). Expert consensus on gender criteria for assessment in medical communication education. Patient Education and Counseling, 88(2), 189–195.  https://doi.org/10.1016/j.pec.2012.01.013.CrossRefGoogle Scholar
  12. Dielissen, P., Verdonk, P., Wieringa-de Waard, M., Bottema, B., & Lagro-Janssen, T. (2014). The effect of gender medicine education in GP training: A prospective cohort study. Perspectives on Medical Education, 3, 343–356.  https://doi.org/10.1007/s40037-014-0122-3.CrossRefGoogle Scholar
  13. Eisenberg, K., Dahlstrom, T., Carnovale, A. J., Neeman, T., & Ellwood, D. (2013). Gender awareness in medical curriculum: Surveying final year students undertaking a Women’s Health rotation. Medical Teacher, 35(11), 970–971.  https://doi.org/10.3109/0142159x.2013.786818.CrossRefGoogle Scholar
  14. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.  https://doi.org/10.1126/science.847460.CrossRefGoogle Scholar
  15. Evans, J. D. (1996). Straightforward statistics for the behavioral sciences. Pacific Grove, CA: Brooks/Cole Publishing.Google Scholar
  16. Glick, P., & Fiske, S. (1996). The Ambivalent Sexism Inventory: Differentiating hostile and benevolent sexism. Journal of Personality and Social Psychology, 70(3), 491–512.  https://doi.org/10.1037/0022-3514.70.3.491.CrossRefGoogle Scholar
  17. Guillemin, F., Bombardier, C., & Beaton, D. E. (1993). Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed outlines. Journal of Clinical Epidemiology, 46, 1417–1432.  https://doi.org/10.1016/08954356(93)90142-N.CrossRefGoogle Scholar
  18. Hamberg, K. (2008). Gender bias in medicine. Women’s Health, 4(3), 237–243.  https://doi.org/10.2217/17455057.4.3.237.CrossRefGoogle Scholar
  19. Hojat, M. (2009). Ten approaches for enhancing empathy in health and human services cultures. Journal of Health and Human Services Administration, 31(4), 412–450.Google Scholar
  20. Hojat, M., Gonnella, J., Mangione, S., Nasca, T., & Magee, M. (2003). Physician empathy in medical education and practice: Experience with The Jefferson Scale of Physician Empathy. Seminars in Integrative Medicine, 1(1), 25–41.  https://doi.org/10.1016/S1543-1150(03)00002-4.CrossRefGoogle Scholar
  21. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.  https://doi.org/10.1080/10705519909540118.CrossRefGoogle Scholar
  22. Humphries, K. H., Izadnegahdar, M., Sedlak, T., Saw, J., Johnston, N., Schenck-Gustafsson, K., et al. (2017). Sex differences in cardiovascular disease: Impact on care and outcomes. Frontiers in Neuroendocrinology, 46, 46–70.  https://doi.org/10.1016/j.yfrne.2017.04.001.CrossRefGoogle Scholar
  23. IBM Corp. Released. (2015). IBM SPSS statistics for windows, version 23.0. Armonk, NY: IBM Corp.Google Scholar
  24. Khoury, A. J., & Weisman, C. S. (2002). Thinking about Women’s Health: the case for gender sensitivity. Women’s Health Issues, 12(2), 61–65.CrossRefGoogle Scholar
  25. Magalhães, E., Salgueira, A., Costa, P., & Costa, M. J. (2011). Empathy in senior year and first year medical students: A cross-sectional study. BMC Medical Education, 11(52), 1–7.  https://doi.org/10.1186/1472-6920-11-52.CrossRefGoogle Scholar
  26. Maroco, J. (2010). Análise de equações estruturais: fundamentos teóricos, software e aplicações. Report Number Lda: Pêro Pinheiro.Google Scholar
  27. Miller, P., Vogt, L., King, J., & King, D. (1999). Gender ideology, sensitivity and knowledge: A model of gender awareness in VA health care. Veterans Health System Journal, 4, 27–30.Google Scholar
  28. Mosca, L., Barrett-Connor, E., & Wenger, N. K. (2011). Sex/gender differences in cardiovascular disease prevention. Circulation, 124(19), 2145–2154.  https://doi.org/10.1161/CIRCULATIONAHA.110.968792.CrossRefGoogle Scholar
  29. O’Connor, B. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instrumentation, and Computers, 32, 396–402.  https://doi.org/10.3758/BF03200807.CrossRefGoogle Scholar
  30. Ordem dos Psicólogos Portugueses. (2011). Código Deontológico [Brochura]. Lisboa: OPP.Google Scholar
  31. Poinhos, R. (2011). Viés de Género na Medicina. Acta Médica Portuguesa, 24, 975–986.Google Scholar
  32. PORDATA. (2019). Alunos matriculados no ensino superior na área da Saúde: total, por área de educação e formação e sexo. [On-line]. Retirado de https://www.pordata.pt/Portugal/Alunos+matriculados+no+ensino+superior+na+%C3%A1rea+da+Sa%C3%BAde+total++por+%C3%A1rea+de+educa%C3%A7%C3%A3o+e+forma%C3%A7%C3%A3o+e+sexo-802.
  33. Ridgeway, C. L., & Correll, S. J. (2004). Unpacking the gender system: A theoretical perspective on gender beliefs and social relations. Gender and Society, 18, 510–531.  https://doi.org/10.1177/0891243204265269.CrossRefGoogle Scholar
  34. Salgado, D., Vogt, D., King, L., & King, D. (2002). Gender Awareness Inventory-VA: A measure of ideology, sensitivity, and knowledge related to Women Veterans’ Health Care. Sex Roles, 46(7/8), 247–262.  https://doi.org/10.1023/A:1020171416038.CrossRefGoogle Scholar
  35. Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit o structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research, 8(2), 23–27.Google Scholar
  36. Schmitt, T. A. (2011). Current methodological considerations in exploratory and confirmatory factor analysis. Journal of Psychoeducational Assessment, 29(4), 304–321.  https://doi.org/10.1177/0734282911406653.CrossRefGoogle Scholar
  37. Stangor, C., & Leary, S. (2006). Intergroup beliefs: Investigations from the social side. Advances in Experimental Social Psychology, 38, 243–283.Google Scholar
  38. Swann, W. B., Jr., Langlois, J. H., & Gilbert, L. A. (Eds.). (1999). Sexism and stereotypes in modern society: The gender science of Janet Taylor Spence. Washington, DC: American Psychological Association.Google Scholar
  39. Verdonk, P., Benschop, Y., De Haes, H., & Lagro-Janssen, T. (2008). Medical students’ gender awareness construction of the Nijmegen Gender Awareness in Medicine Scale (N-Gams). Sex Roles, 58, 222–234.  https://doi.org/10.1007/s11199-007-9326-x.CrossRefGoogle Scholar
  40. Verdonk, P., Benschop, Y., de Haes, H., Mans, L., & Lagro-Janssen, T. (2009). Should you turn this into a complete gender matter? Gender mainstreaming in medical education. Gender and Education, 21(6), 703–719.  https://doi.org/10.1080/09540250902785905.CrossRefGoogle Scholar
  41. Wei, Y.-C., George, N. I., Chang, C.-W., & Hicks, K. A. (2017). Assessing sex differences in the risk of cardiovascular disease and mortality per increment in systolic blood pressure: A systematic review and meta-analysis of follow-up studies in the United States. PLoS ONE, 12(1), 1–15.  https://doi.org/10.1371/journal.pone.0170218.CrossRefGoogle Scholar
  42. Zebrowitz, L. A., Bronstad, P. M., & Lee, H. K. (2007). The contribution of face familiarity to ingroup favoritism and stereotyping. Social Cognition, 25(2), 306–338.  https://doi.org/10.1521/soco.2007.25.2.306.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Instituto Universitário de Lisboa (ISCTE-IUL)LisbonPortugal
  2. 2.Centro de Investigação e Intervenção Social (CIS-IUL)LisbonPortugal
  3. 3.Amsterdam UMC, Department Medical Humanities, APH Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands

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