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      Gender health gaps in guideline-based inpatient cardiovascular medical and nursing care and implementation strategies to reduce the gap (HeartGap): A mixed methods study protocol

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          Abstract

          Background

          A growing body of evidence has demonstrated that a gender-sensitive approach to healthcare is needed in all areas of medicine. Although medical and nursing guidelines include gender-sensitive care (GSC+) recommendations, the level of implementation in health care practice is unknown. This study aims to examine the current level of implementation and acceptance of GSC+ among physicians and nurses and to identify potential gaps between guidelines and practice and barriers and facilitators of GSC+ implementation, taking the perceptions of all relevant stakeholders into account. The overarching aim is to develop holistic recommended actions to strengthen GSC+.

          Methods

          This study has a mixed methods triangulation design. The preparation phase consisting of a literature review and a two-part (qualitative and quantitative) data analysis will be conducted in the cardiology department of 9 pilot hospitals in Berlin, North Rhine-Westphalia, Lower Saxony, Rhineland-Palatinate, Germany. 18 focus groups with clinicians and nurses as well as interviews with experts in other relevant fields will be performed. In the national roll-out phase, a questionnaire survey will be conducted with hospital clinicians (n = 382), nurses (n = 386) and patients (n = 388).

          Discussion

          This study will provide comprehensive insights into the implementation and acceptance of GSC+ in cardiology from the perspective of doctors, nurses, patients, stakeholders and experts in relevant fields, such as policy and education. A focus will also be on the extent to which age or gender of health professionals, region and hospital type influence the implementation of GSC+. The identification of GSC+ implementation barriers and facilitators should help to improve the standard of care for cardiology patients of all genders. The outcomes from this study can be used to develop measures and recommended actions for the successful and sustainable implementation of gender-sensitive care.

          Trial registration

          The study is registered in the German Register of Clinical Studies (DRKS) under study number DRKS00031317.

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          Most cited references12

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          The updated Consolidated Framework for Implementation Research based on user feedback

          Laura Damschroder, Caitlin Reardon, Marilla A. Opra Widerquist … (2022)
          Background Many implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors; however, it has been over 10 years since publication and there is a need for updates. The purpose of this project was to elicit feedback from experienced CFIR users to inform updates to the framework. Methods User feedback was obtained from two sources: (1) a literature review with a systematic search; and (2) a survey of authors who used the CFIR in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2. Results The systematic search yielded 376 articles that contained the CFIR in the title and/or abstract and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n = 134/334) of authors completed the survey. The CFIR received positive ratings on most framework sensibility items (e.g., applicability, usability), but respondents also provided recommendations for changes. Overall, updates to the CFIR include revisions to existing domains and constructs as well as the addition, removal, or relocation of constructs. These changes address important critiques of the CFIR, including better centering innovation recipients and adding determinants to equity in implementation. Conclusion The updates in the CFIR reflect feedback from a growing community of CFIR users. Although there are many updates, constructs can be mapped back to the original CFIR to ensure longitudinal consistency. We encourage users to continue critiquing the CFIR, facilitating the evolution of the framework as implementation science advances. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01245-0.
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            Bringing gender sensitivity into healthcare practice: a systematic review.

            G. Widdershoven, Olaf Janssen, Halime Celik … (2011)
            Despite the body of literature on gender dimensions and disparities between the sexes in health, practical improvements will not be realized effectively as long as we lack an overview of the ways how to implement these ideas. This systematic review provides a content analysis of literature on the implementation of gender sensitivity in health care. Literature was identified from CINAHL, PsycINFO, Medline, EBSCO and Cochrane (1998-2008) and the reference lists of relevant articles. The quality and relevance of 752 articles were assessed and finally 11 original studies were included. Our results demonstrate that the implementation of gender sensitivity includes tailoring opportunities and barriers related to the professional, organizational and the policy level. As gender disparities are embedded in healthcare, a multiple track approach to implement gender sensitivity is needed to change gendered healthcare systems. Conventional approaches, taking into account one barrier and/or opportunity, fail to prevent gender inequality in health care. For gender-sensitive health care we need to change systems and structures, but also to enhance understanding, raise awareness and develop skills among health professionals. To bring gender sensitivity into healthcare practice, interventions should address a range of factors. Copyright © 2010. Published by Elsevier Ireland Ltd.
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              Why are we failing to implement effective therapies in cardiovascular disease?

              Salim Yusuf, Robby Nieuwlaat, Jon-David Schwalm … (2013)
              Worldwide, there are ~18 million deaths each year from cardiovascular disease and at least 2-3 times as many experience non-fatal cardiovascular events. Numerous evidence-based prevention and management guideline recommendations for cardiovascular disease are available. However, significant gaps between the evidence and its implementation persist ('evidence-practice gap'). There exist 'under-use' gaps with lack of implementation of proven effective strategies and 'over-use' gaps with inappropriate use of strategies with strong evidence against, or insufficient evidence for their effectiveness and safety. To better tackle the global burden of cardiovascular disease (CVD), more effective strategies are needed. We discuss three selected areas where advances in implementation research for CVD could provide improvements. First, a better assessment and understanding of the most important modifiable context-specific barriers to evidence-based care will allow optimal tailoring of interventions to overcome them. Second, novel community intervention strategies from outside current CVD research should be considered, especially for CVD areas where major barriers exist and little progress has been made. Examples of such interventions include cell phone text messaging, non-physician health workers for the delivery community CVD care in areas of need, and low-cost single-pill combination CVD therapy. Third, increasing our understanding of successful implementation and sustainability of improvements is essential for CVD as a widespread chronic disease. Learning how to better implement effective therapies for CVD will have a larger effect on patient outcomes than most single new drugs and is a priority for tackling the global burden of CVD.
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                Author and article information

                Contributors
                Sophia Sgraja:
                ORCID: https://orcid.org/0009-0006-9104-7585
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draft
                Judith Mollenhauer: Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draft
                Martina Kloepfer: Role: ConceptualizationRole: Funding acquisitionRole: Writing – review & editing
                Ute Seeland:
                ORCID: https://orcid.org/0000-0002-1979-386X
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Clarissa Kurscheid: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Volker Amelung: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Farhadul Islam: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 18 April 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 4
                Electronic Location Identifier: e0301732
                Affiliations
                [1 ] Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hanover, Germany
                [2 ] figus–Research Institute for Health- and System Design, Cologne, Germany
                [3 ] Institute for Gender Health, Berlin, Germany
                [4 ] Institute for Social Medicine, Epidemiology and Health Economics, Charité, Berlin, Germany
                University of Rajshahi, BANGLADESH
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0009-0006-9104-7585
                https://orcid.org/0000-0002-1979-386X
                Article
                Publisher ID: PONE-D-23-41289
                DOI: 10.1371/journal.pone.0301732
                PMC ID: 11025927
                PubMed ID: 38635776
                SO-VID: ed7151b4-a0b2-4585-87c9-d84cfda9827a
                Copyright © © 2024 Sgraja et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 January 2024
                Date accepted : 19 March 2024
                Page count
                Figures: 2, Tables: 1, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100014840, Gemeinsame Bundesausschuss;
                Award ID: 01VSF22030 HeartGap
                Award Recipient :
                The project is funded by the German Innovation Fund with the funding number: 01VSF22030. Projects funded by the German Innovation Fund run through an assessment procedure that correspond to a peer-review. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Study Protocol
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Providers
                Subject: Allied Health Care Professionals
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Medical Personnel
                Subject: Nurses
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Providers
                Subject: Nurses
                Subject: Medicine and Health Sciences
                Subject: Medical Humanities
                Subject: Medical Ethics
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Providers
                Subject: Physicians
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Medical Personnel
                Subject: Physicians
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Nursing Science
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Myocardial Infarction
                Subject: People and places
                Subject: Geographical locations
                Subject: Europe
                Subject: European Union
                Subject: Germany
                Custom metadata
                Data Availability No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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