Multifarious approaches of implementation to transfer gender sensitivity in health care practice: a scoping review

Gender-sensitive care (GSC+) is part of patient-centered care and necessary for adequate patient outcome. Implementation measures are needed to close the gap between evidence-based medicine and nursing and lacking gender-sensitive daily care. The present scoping review is part of the German Innovation Fund project HeartGap (funding number: 01VSF22030), is registered in the German Register of Clinical Studies (clinical trial registry number: DRKS 00031317, registration date: 24.02.2023), and aims to identify measures, facilitators, and barriers to enhance a sustainable implementation process of GSC+.

Literature was identified from PubMed, web of science and CINAHL (2008-2023). The relevance of 23,508 articles was assessed and content analyzed. The systematic search, snowball principle, and hand search brought a total of 117 articles. The included articles were subsumed in one of the four derived main dimensions (i) politics, (ii) research/science, (iii) education, and (iv) institutions of care. The implementation of GSC+ in institutions of care (inner setting) is dependent on outer factors such as political decisions, education, or research/science (outer settings).

The results demonstrate facilitators and barriers, which influence the implementation of GSC+. Key measures regarding main dimensions are described as follows: (i) Politics provides the framework for the implementation of GSC+. Lobbying is a useful instrument to enhance awareness of politics. Learning from international best-practice concepts and promoting career advancement facilitates the implementation. (ii) Generating evidence by conducted studies enables the integration of GSC+ content through professional associations in guidelines. (iii) Educating (future) health care providers through GSC+ training programs, journal clubs and mandatory integration into the curricula enhances awareness of patient´s diversity. (iv) For implementing changes in daily care routine, the implementation process should be accompanied and structured by change agents. A handbook on how to organize quality circles facilitates the change process.

The implementation of GSC+ is a cross-dimensional task. There are already many measures that can sustainably improve gender sensitivity in the dimensions. There is still a lack of compulsory requirements for implementation and recommended actions to ensure that GSC+ is considered in practice.