title: Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients--A Study of Pain Rehabilitation.
abstract: OBJECTIVE
  There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.
  
  
  METHODS
  In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.
  
  
  RESULTS
  The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.
  
  
  CONCLUSIONS
  The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.
  
  
  CONCLUSIONS
  Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.
authors.affiliation: Department of Public Health and Clinical Medicine, Unit of Social Medicine, Umeå University, Umeå, Sweden.|Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Hammarström
authors.affiliation: Department of Public Health and Clinical Medicine, Unit of Social Medicine, Umeå University, Umeå, Sweden.|Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Wiklund
authors.affiliation: Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Stålnacke
authors.affiliation: Department of Clinical Sciences, Unit of Professional Development, Umeå University, Umeå, Sweden.
authors.forename: Arja
authors.initials: A
authors.lastname: Lehti
authors.affiliation: Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Kalfarveien 31, Bergen, Norway.|Research Unit for General Practice, Uni Research Health, Kalfarveien 31, Bergen, Norway.
authors.forename: Inger
authors.initials: I
authors.lastname: Haukenes
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
authors.forename: Anncristine
authors.initials: A
authors.lastname: Fjellman-Wiklund
mesh_terms: D001364:Awareness; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D010146:Pain / Q000453:epidemiology / Q000503:physiopathology* / Q000534:rehabilitation*; D059408:Pain Management / Q000379:methods; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires