General Discussion 209 8 Methodological considerations and limitations The work presented in this thesis provided new insights into the study of gender in PD research. I have used different study designs and methods to investigate the impact of gender in PD ranging from literature reviews, survey-based inquiries, individual in-depth and focus group interviews and design-based explorations. A multiphase investigation with different methods is a useful way to obtain different but complementary data on the same topic. However, there are several methodological considerations and limitations that should be considered when interpreting the findings of this thesis. External validity of the findings As gender-related aspects are based on social processes, some of the findings could be generalizable to other patient populations with (and without) chronic neurological condition, such as (self-)stereotyping behaviours that affect coping with emotional experiences and help seeking behaviours. Previous studies have suggested that, in general, men who adhere to traditional masculine norms related to ‘toughness’ are more likely to discourage themselves for help-seeking when emotionally distressed through self-stereotyping.1,2 Some of the women who participated in the studies presented in this thesis experienced that performing certain feminine gender roles related to ‘household and caring tasks’ and ‘social organizing’ could mask their difficulties with PD related symptoms observed by others, including healthcare professionals, and can contribute to feelings of invisibility and not being taken seriously when communicating experienced difficulties with PD. These examples might be illustrative of general forms of benevolent sexism that rewards men and women for the performance of ‘positive’ stereotypical gender roles while undermining their capacity to effectively assert agency over their own health.3 While these findings can be viewed as general reflections of the impact of social gender norms in illness experiences, they are also reflections of the impact of disease specific symptom presentations that highlight particular gender norms in illness experiences of people with PD. For example, masculine norms related to ‘toughness’ are potentially stronger social regulators for some men when their physical functioning is increasingly impaired by the progression of PD. Also, a contributor to the feeling of invisibility among women with PD was related to the disease specific stereotype of ‘people with PD are old men’. These examples illustrate that while the impact of gender roles and norms on illness experiences are reflections of broader societal social structures, particular gender norms and roles can become highlighted in illness experiences by diseasespecific disabilities and stereotypes. This interpretation would limit the generalizability of some findings to other chronic neurological conditions yet should encourage the replication of these studies among different patient populations.
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