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The WHISK (Women's Health: Increasing the Awareness of Science and Knowledge) Pilot Project: Recognizing Sex and Gender Differences in Women's Health

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Abstract

Women's health encompasses a continuum of biological, psychological, and social challenges that differ considerably from those of men. Despite the remarkable advances in science, women's health and sex differences research is slowly gaining recognition and acceptance. It is important that women's health gain attention as women are usually the gatekeepers of care for the family. Women's health and health outcomes are strongly influenced by sex and gender differences as well as geography. Around the world, the interplay of biology and culture brings about differences in men's and women's health, which have been largely overlooked. The Women's Health: Increasing the Awareness of Science and Knowledge (WHISK) Pilot Project was a multidisciplinary project aimed to increase the awareness of sex and gender differences in women's health and research among healthcare professionals. Theater expression and creative art were used to translate knowledge, enhance understanding, and increase the awareness of sex differences. Findings from this project clearly showed an apparent increase in knowledge and cultivation of new insights. 抽象 Read More: http://www.gahmj.com/doi/abs/10.7453/gahmj.2013.053
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Volume 2, Number 5 • September 2013 • www.gahmj.com
GLOBAL ADVANCES IN HEALTH AND MEDICINE
Original Research
The WHISK (Women’s Health: Increasing the Awareness of
Science and Knowledge) Pilot Project: Recognizing Sex and
Gender Differences in Women’s Health and Wellness
WHISK(女性健康:增强科学意识,提高知识知晓程度)试点项目:确认女性健康和幸
福方面的两性和性别差异
El proyecto piloto WHISK (Salud de las mujeres: una mayor concienciación de la
ciencia y el conocimiento): el reconocimiento de las diferencias de sexo y género
en la salud y el bienestar de las mujeres
Lorece V. Edwards, DrPH, United States; Sabriya Dennis, MA, United States; Francesca Weaks, BS, MS, United States
ORIGINAL RESEARCH
Author Affiliations
Morgan State University,
School of Community
Health and Policy,
Baltimore, Maryland.
Correspondence
Lorece V. Edwards, DrPH
lorece.edwards@
morgan.edu
Citation
Global Adv Health Med.
2013;2(5):54-58. DOI:
10.7453/gahmj.2013.053
Key Words
Sex and gender
differences, women’s
health, community
engagement
Disclosures
The authors completed
the ICMJE Form for
Disclosure of Potential
Conflicts of Interest
and indicated no
potential conflicts.
ABSTRACT
Women’s health encompasses a con-
tinuum of biological, psychological,
and social challenges that dier con-
siderably from those of men. Despite
the remarkable advances in science,
women’s health and sex dierences
research is slowly gaining recognition
and acceptance. It is important that
women’s health gain attention as
women are usually the gatekeepers of
care for the family. Women’s health
and health outcomes are strongly
influenced by sex and gender dier-
ences as well as geography. Around the
world, the interplay of biology and
culture brings about dierences in
men’s and women’s health, which
have been largely overlooked. The
Women’s Health: Increasing the
Awareness of Science and Knowledge
(WHISK) Pilot Project was a multidis-
ciplinary project aimed to increase the
awareness of sex and gender dierenc-
es in women’s health and research
among healthcare professionals.
Theater expression and creative art
were used to translate knowledge,
enhance understanding, and increase
the awareness of sex dierences.
Findings from this project clearly
showed an apparent increase in knowl-
edge and cultivation of new insights.
抽象
女性健康围绕着一个由生物、心理
和社会挑战组成的连续统一体,而
该等挑战与男性所面临的挑战有很
大区别。尽管我们在科学上已经取
得了非凡的进展,但女性健康和两
性差异研究却还在逐步获得认可和
接受。关注女性健康至关重要,因
为女性通常担负着守护家人健康的
重任。女性健康和健康结果受两性
和性别差异以及地域的强烈影响。
在全世界范围内,生物学与文化
之间的相互作用造成了男性健康
与女性健康的差异,而这却在很
大程度上被人们所忽视。WHISK 试
点项目是一个多学科项目,旨在
提高医疗护理专业人士对女性健
康和研究方面的两性和性别差异
的意识,并采用戏剧性的表达和
创造性的艺术来解释
两性差异知识,增强对两性差异
的理解和提高对两性差异的意
识。本项目的发现清楚表明,医
疗护理专业人员对相关知识的知
晓程度明显提高,并且还培养出
许多新的观点。
SINOPSIS
La salud de las mujeres abarca un
continuo de retos biológicos, psi-
cológicos y sociales que difieren con-
siderablemente de los de los hombres.
Pese a los notables avances de la cien-
cia, la investigación sobre la salud de
las mujeres y las diferencias entre
sexos va obteniendo reconocimiento
y aceptación con mucha lentitud. Es
importante que la salud de las
mujeres consiga atraer la atención,
pues las mujeres controlan por lo
general el acceso de la atención médi-
ca a la familia. La salud y los resulta-
dos médicos de las mujeres están
fuertemente influidos por las diferen-
cias de sexo y género y por la geo-
grafía. En todo el mundo la interac-
ción entre biología y cultura provoca
diferencias entre hombres y mujeres
en cuanto a la salud, diferencias que
durante mucho tiempo se han obvia-
do. El proyecto piloto WHISK fue un
proyecto multidisciplinario cuyo
objetivo era aumentar la concien-
ciación sobre las diferencias de sexo y
género en la salud de las mujeres y la
investigación entre los profesionales
sanitarios. Se utilizó la expresión teat-
ral y el arte creativo para reflejar los
conocimientos, ampliar la compren-
sión y aumentar la concienciación
sobre las diferencias entre sexos. Los
resultados de este proyecto mostra-
ban con claridad un visible aumento
del conocimiento y el desarrollo de
nuevas perspectivas.
INTRODUCTION
Women’s health encompasses a continuum of
biological, psychological, and social challenges that
differ considerably from those of men.1 Despite the
remarkable advances in science, women’s health and
sex differences research is slowly gaining recognition
and acceptance.2 It is important that women’s health
gain attention as women are usually the gatekeepers of
care for the family. Women’s health and health out-
comes are strongly influenced by sex and gender differ-
ences as well as geography. Around the world, the
interplay of biology and culture brings about differ-
ences in men’s and women’s health, which have been
largely overlooked.3 When it comes to health among
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55
Original Research
THE WHISK PILOT PROJECT
the sexes (men and women)—sex does matter.
Although women tend to live longer than men (on
average 5 years) almost everywhere, they suffer from
more illnesses and disabilities throughout their lives.1
SEX AND GENDER DIFFERENCES IN WOMEN’S HEALTH
Though women’s health often is the focus of dis-
eases such as breast and ovarian cancers and those of the
reproductive system, it is in fact a much more encom-
passing field, and the study of health and disease in both
sexes is important to advancing the health of women.4
According to Clayton and Joseph (2013), the goal of sex
differences research is to learn how biologic mecha-
nisms, disease manifestation, and therapeutic responses
may be developed. Furthermore, sex differences research
has the power and robustness to be beneficial to both
men and women by informing the delivery of more per-
sonalized, sex-appropriate care3 and gender-specific
medicine. It is critical that new advances in research and
science and the translation of new information be shared
across the spectrum of healthcare professionals to
advance women’s health.
The initial focus of “sex and gender” health emerged
at the level of medical education.5 However, initiatives
to integrate gender issues or women’s health issues into
the curricula have gained momentum. As efforts con-
tinue to address this critical need, researchers, educators,
and healthcare providers struggle with how to incorpo-
rate information generated from the growing discipline
of sex and gender–based medicine into educational and
training programs that will ultimately impact patient
care5 and improve health outcomes for women.
The Association of Schools of Public Health (ASPH)
in collaboration with the US Department of Health and
Human Services (DHHS) conducted a study to assess
how women’s health is addressed in required public
health education.6 The primary findings of the project
suggested that public health curricula should incorpo-
rate various educational components of sex differences
(eg, knowledge of the major sex differences in health
across the life span). Specific findings suggested that sex
and gender differences, diversity within gender, social
determinants of health, and a lifespan perspective should
provide the foundational efforts to incorporate women’s
health into public health core curriculum.7 Through this
project, ASPH and its federal partners sought to increase
available information regarding women’s health issues
across the life span.
ART AND HEALTH
During the past decade, health professionals have
cautiously begun to look at the variety of ways in which
art might be used to heal emotional injuries, increase
understanding of oneself and others, develop a capacity
for self-refection, reduce symptoms, and alter behaviors
and thinking patterns.8 The use of art-based health
research (ABHR), arts, and new media can serve as vehi-
cles for change and knowledge dissemination. ABHR, an
interdisciplinary collaboration among arts, humanities,
health, and social sciences, is receiving much attention,
characterized by enthusiasm for the creation of new
knowledge and new forms of knowledge translation.9 As
a matter of fact, there is a burgeoning of ABHR in various
fields including education, nursing, sociology and other
sciences, and communication studies.10
Theatrical expression is an ancient tradition and has
taken on countless forms and purposes throughout his-
tory.11 Furthermore, since its inception as an art form,
theater, or dramatic representation, has been used not
only for the purposes of entertainment but also as means
to inspire thought, critical reflection, emotional engage-
ment, and personal transformation.10 According to
Rossiter et al (2008), theater has a rich history of impart-
ing information. However, researchers have been slow to
bridge this disciplinary chasm, and this is especially true
for medical and health-related knowledge.
One of the ways that people come together to be
heard and influence their communities is through com-
munity-based theater.12 Community-based theater is a
form of sociopolitical theater that takes a critical posi-
tion toward social issues like women’s health and aims
to raise the awareness. Moreover, community-based
theater is a form of grassroots theater embedding art and
scholarly outreach that includes significance (impor-
tance of the issue); context (appropriateness of the exper-
tise and methods); scholarship (addresses application,
generation, and utilization of the knowledge); and
impact (consists of the effect and benefits of the project
issues).13 A powerful component of community-based
theater is the sharing of commonality. Theater groups
focus on examining social issues through their works
and often share common experiences in their day-to-day
lives.13 In addition, theatrical activities often relate to
personal and social change processes.
METHODS
The Women’s Health: Increasing the Awareness of
Science and Knowledge (WHISK) Pilot Project was a
multidisciplinary project that aimed to increase the
awareness of sex and gender differences in women’s
health and research among university/college students,
faculty, librarians, and health professionals. An objective
of the project was to increase healthcare professionals’
awareness of, access to, and utilization of, the National
Library of Medicine’s women’s health electronic resourc-
es. In addition, the researchers incorporated sex and
gender based differences research and health outcomes
into existing curricula in relevant courses (eg, the public
health program, nutritional sciences and nursing pro-
grams, and health education and women’s studies
departments). As the primary goal of this project was to
increase awareness of sex and gender differences in
women’s health and research, the social marketing
model was selected to guide its implementation. The
social marketing model includes six phases: planning
and strategy, selecting channels and materials, develop-
ing pre- and posttesting, implementation, assessing
effectiveness, and considering feedback for refinement.6
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GLOBAL ADVANCES IN HEALTH AND MEDICINE
Original Research
In addition, we employed creative arts and community-
based theater to engage our audiences and social net-
working and technology as vehicles for recruitment.
We focused on creative arts communication and
community-based theater to transfer knowledge and to
increase the awareness of women’s health and wellness
research. Our aim was to focus on how art-based
approaches can contribute to knowledge awareness and
translation, women’s health, and well-being.
The project was conducted on the campus of
Morgan State University (MSU), a 4-year coeducational
institution located in a residential section of Baltimore,
Maryland, in the United States. Nestled within the urban
academy, there is total of 7226 students and more than
630 faculty members. MSU is the home of the School of
Community Health & Policy (SCHP), which is the pri-
mary site for the project due to its expertise in public and
community health, health equity, the social determi-
nants of health, and social justice.
Participants were recruited via traditional formats
such as flyers and postcards. However, we also employed
social networking and technology (eg, Facebook,
Twitter) to recruit a new generation of scholars.
According to the Pew Research Center, minority adults
outpace whites in their use of social technologies.14 The
inclusion criteria were healthcare professionals, particu-
larly females, whom were recruited from the public
health, nursing, nutritional sciences, and health educa-
tion programs between July 13, 2012, and September 12,
2012. However, we opened up our training sessions to
others who were interested in women’s health/wellness
and sex differences.
From July 13, 2012, through September 12, 2012, we
provided sex differences educational training and out-
reach to a total of 309 participants, who included health-
care professional faculty (50 participants), students (126
participants), and special groups (43 participants of
female-led peer educators and sororities) through cre-
ative arts and community-based theater.
SCHP collaborated with a community grassroots
organization, Womb Work Productions Inc (Baltimore,
Maryland). Womb Work is a fully comprehensive pro-
duction company that uses performing arts as a tool to
provide education and increase the awareness of perti-
nent issues (eg, women’s health, HIV/AIDS, world hun-
ger). This provided an opportunity for the application of
new learning.
The most widely used evaluation design is a tradi-
tional pre- and posttest, where participants are asked a
series of questions at both the beginning of a program
(pretest) and then again at the program’s completion
(posttest). This design is believed to measure changes in
participants’ knowledge, attitudes, or behaviors regard-
ing the program content (eg, sex and gender differences).
The idea of pre- and posttests is often accepted as a viable
method to assess the extent to which an educational
program has had an impact on learning. To assess
knowledge of sex differences in women’s health/health
outcomes and research, a pretest/posttest design was
implemented to assess any new learning among the
participants. The primary questions, listed below, were
constructed based on measurements of awareness and
knowledge of sex and gender differences in women’s
health, health outcomes, and research and were asked in
the form of yes-or-no questions.
Historically, have women been included in research?
Is there a difference between sex and gender?
Do sex and gender matter in disease diagnosis, man-
ifestation, course, and treatment?
Are you aware of the sex and gender differences in
the symptoms of cardiovascular disease (CVD)
based on gender?
Are you aware of the sex and gender differences in
the transmission of sexually transmitted infections?
Do sex and gender matter in response to
pharmaceuticals?
Are you aware of the National Institutes of Health
Women’s Health Electronic Resource?
Additionally, the posttest captured comments
from the participants regarding what they learned.
RESULTS/FINDINGS
The present pilot project was conducted to increase
the awareness of sex and gender differences in women’s
health, research, and health outcomes. SCHP collabo-
rated with Womb Work to increase the awareness of
women’s health and the importance of sex and gender
differences in disease manifestation, course, treatment,
and outcomes. Their productions were tailored and
designed to increase the awareness of specific issues (eg,
women are twice as likely as men to contract a sexually
transmitted disease [STD]), relieve the stress of an unbal-
anced society (eg, through music and dance), and better
understand social conditions as well as health disparities
(eg, gender influences health). The WHISK Pilot Project
team provided three educational sessions with Womb
Work to provide state-of-art and evidence-based infor-
mation on sex and gender differences research and
women’s health. Data were gathered from various
PubMed peer-reviewed articles, consultations with the
Society for Women’s Health Research (SWHR), and the
National Institutes of Health Office of Research on
Women’s Health (ORWH). Womb Work designed and
implemented a creative arts and community-based the-
ater performance entitled, “Do You Really Know About
Sex and Gender Differences and Women’s Health?”
Given the promise of theater to provide new oppor-
tunities for the analysis, representation, and transfer of
data/knowledge, health researchers have begun to show
interest in performance art as a means of interpreting,
enlivening, and enriching their findings.10 The Womb
Work theater performance was informed as well as
guided by the pretest/posttest questions to transfer
knowledge through creative arts and theater expres-
sions, thereby increasing the awareness of sex differenc-
es and enhancing the understanding of sex and gender
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57
THE WHISK PILOT PROJECT
differences in health and disease pathophysiology.
Findings from the project are listed in Figures 1 and 2.
Of the participants, 78% (n=241) were not aware
of sex and gender differences in women’s health and
disease manifestation. Although a few of the partici-
pants assumed that there are some differences relative
to health based on sex, they still referred to women as
small men. Based on the lack of awareness and knowl-
edge relative to sex and gender differences in women’s
health, it is clear that there is a need to increase aware-
ness among several populations (eg, medical students,
health professionals, and consumers). Participants
clearly articulated that they were not aware that
women react differently to medications, are more vul-
nerable to certain diseases (eg, autoimmune diseases,
osteoporosis, and HIV/sexually transmitted infections),
and have different symptoms.
CVD is the primary cause of mortality for both men
and women. Of the participants, approximately 85%
(n=262) were unaware of the serious differences between
men and women relative to CVD. Furthermore, partici-
pants were not aware that women are more likely than
men to have more than one heart attack and that more
than 50 000 more women than men die from heart dis-
ease annually. Once again, participants referred to
women as small men.
Of the participants, 65% (n=200) were not aware of
the sex and gender differences that occur in relation to
STDs. Roughly 35% of the participants were aware that
women are two times more likely than men to contract
an STD and that HIV is among the leading causes of
death for US women.
Posttest data provide a clear picture that the goal of
the WHISK Pilot Project was achieved. There was an
increase in awareness and knowledge about sex and gen-
der differences in women’s health and disease manifesta-
tion among the participants. The areas with the greatest
impact were women’s experience of CVD and awareness
of and access to the women’s health electronic resources.
Additionally, 85% of the participants gained knowledge
and awareness of the diagnosis, course, and treatment of
CVD among women. Furthermore, participants became
aware of the symptoms of a myocardial infarction (eg,
upper back pain, jaw pain, fatigue, and nausea) based on
gender. All of the participants learned about the wealth
of women’s health electronic resources. Of note, the
results of this project are subject to some limitations.
Some of the participants did not participate in the com-
munity-based theater educational sessions.
CONCLUSIONS
The findings from the pretest/posttest data suggest
that, after the training and community-based theatrical
performances, participants demonstrated more knowl-
edge of sex and gender differences in women’s health
and health outcomes and awareness of the National
Institutes of Health Office of Research on Women’s
Health electronic resources. In all categories, there was
an apparent change in increased knowledge. The small-
est percentage change noted began at 50% (Question: Is
there a difference between sex and gender) and improved
to 100% (Question: Are you aware of the NIH Women’s
Health Electronic Resource?). The changes clearly illus-
trate the effectiveness of providing evidence-based and
reliable information that also takes into account the
culture and diversity of the participants.
One of the most important areas of increased knowl-
edge was the inclusion of women in research. After the
education training, 70% of the participants were aware
that historically women had been banned from medical
research (1977) due to thalidomide and diethylstilbestrol
prescriptions. A substantial change in learning acquisi-
tion was related to the question about awareness of sex
and gender differences in CVD symptoms. Initially, par-
ticipants were not aware of the different symptoms of
myocardial infarction based on gender. A participant
Original Research
Awareness of CVD symptoms
Women included in research
Sex diff and Trans of STIs
Diff in pharmaceuticals
Sex and Gender and pathophysiology
Diff in sex and gender
Awareness of web resources
0 10 20 30 40 50 60 70 80 90 100
Yes No
Percent
Pre- and Posttest Questions
Figure 1 Pre-test results.
Abbreviations: CVD, cardiovascular disease; diff, difference; STIs, sexually
transmitted infections; trans, transmission.
Awareness of CVD symptoms
Women included in research
Sex diff and trans of STIs
Diff in pharmaceuticals
Diff in sex & gender
Awareness web resources
0 10 20 30 40 50 60 70 80 90 100
Yes No
Percent
Pre- and Posttest Questions
Sex and gender and
pathophysiology
Figure 2 Posttest results.
Abbreviations: CVD, cardiovascular disease; diff, difference; STIs, sexually
transmitted infections; trans, transmission.
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GLOBAL ADVANCES IN HEALTH AND MEDICINE
Original Research
noted on her posttest sheet, “I had no clue that unusual
fatigue and nausea could be symptoms of a heart attack
based on gender. All women should know this informa-
tion. From now on, I will ask my doctors about differences
for my health based on gender.” Differences in reactions
to pharmaceuticals were another area with apparent
change in increased knowledge. Prior to the posttest, 60%
of the participants were not aware that the enzymes that
metabolize certain drugs have different activity levels in
women and men, so drugs are metabolized by these
enzymes at different rates (women metabolize faster),
which may cause more side effects in women than men.
Sex and gender differences training and community-
based theater revealed that women are not “small men.”
Gender plays a role in health, and it cannot be assumed
that a male model for health also applies to women.
DISCUSSION
When it comes to women’s health, sex matters.15
Sex is a crucial biological variable that should be consid-
ered when designing and analyzing studies in all areas
and at all levels of biomedical and health-related
research.15 Sex differences of importance to health and
human disease occur throughout the life span, although
their specific expressions vary at different stages of life.16
According to the Institute of Medicine, sex affects health
in all areas, including health promotion and disease pre-
vention, diagnosis, and treatment.16 Though little can be
done to change biological determinants of health,
improving women’s health requires recognizing and
addressing gender differences as well as inequalities
affecting women and girls of all ages.3 These topics must
become a vital part of educational considerations.
Vast amounts of new scientific data, including
information about sex and gender differences, are emerg-
ing and should be embedded into educational and train-
ing programs for all healthcare professionals. Translating
new knowledge and scientific advances regarding sex
differences will ultimately impact patient care, and men
as well as women will receive the benefits. The barriers
often found in understanding the terms sex and gender
must be removed. Researchers and healthcare profes-
sionals must clearly understand that the terms are dis-
tinct and not synonymous. Every attempt to disseminate
sex differences knowledge will benefit all. There should
be various educational methods to address this very
important discipline using creativity and new innova-
tions for a new cadre of healthcare professionals.
The arts have been a catalyst for change and growth
in a wide range of health-promotion activities, including
awareness efforts. Theater holds great promise in the
world of education and health-related translation of
knowledge.10 By engaging audiences on a cognitive and
sometimes emotional level and by using various forms
of communication, theater has the potential to enhance
complex dynamics,10 the awareness of social issues, and
the understanding of crucial health messages. Through
theater, women not only acquire new insights regarding
sex and gender differences in health, health outcomes,
and research but can have a better understanding of the
role they play for patients and healthcare consumers.
The WHISK Pilot Project through creative arts and
theater expressions enhanced knowledge of sex and
gender differences in women’s health, health outcomes,
and research. A critical component of the learning exer-
cise included sex and gender differences in myocardial
infarction symptoms. Sex and gender differences in CVD
have been well investigated and there is epidemiological
evidence that men and women face different risks and
have different outcomes.17 Through theater expression,
women were able to not only see the symptoms of myo-
cardial infarction played out but were also better able to
understand the significance of CVD.
In general, pilot studies provide the researcher with
ideas, approaches, and clues that may not have been fore-
seen before conducting the pilot study. However, while
this pilot project was extremely valuable, we cannot
ignore the limitations. Limitations of this pilot study
include that it was not designed to be definitive or gener-
alizable. Additionally, time was a limitation; the research-
ers had a limited amount of time to complete the project.
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Acknowledgments
This project was made
possible by funding
from the National
Institutes of Health
Office of Research
on Women’s Health
and the National
Library of Medicine
Outreach and Special
Populations Branch.
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