Chapter 8 210 Furthermore, the samples included in the studies were relatively homogeneous, with men and women with PD from exclusively Dutch descent, in heterosexual relationships and with an average age of 66 years. Therefore, the findings from these studies cannot be generalized to populations with different generational and cultural backgrounds. Distinguishing between people with PD with different sociocultural and generational backgrounds and sexual orientations is tremendously important given the contextual experiences of gender-related performances in various domains such as family, social and work life and during medical encounters.4,5 Studying gender in medicine with different study designs This thesis employed a triangulation of study designs to explore the role of gender and its situated performances in illness experiences of people with PD. In this section, I discuss the use of these study designs and considerations for the operationalization of gender dimensions. Quantitative study design For the survey study described in Chapter 3, a literature review was performed to identify state-of-the-art options for operationalizing the gender dimensions: gender identity, gender roles and gender relations. The inclusion of multiple gender dimensions allows an analysis in which the identity categories of ‘women’, ‘men’ and ‘gender-diverse people’ can be considered as heterogeneous categories with within-groups differences. However, using existing questionnaires or variables to operationalize, for example, gender roles means that what is considered ‘masculine’ or ‘feminine’ is predefined. In Chapter 3 I included the Bem Sex Role Inventory (BSRI), which is currently still the most widely used measure for gender roles. However, the BSRI was validated in 1974 among U.S. students from a private University.6 As cultural ideas about gender evolve over time due to generational differences in views and attitudes towards gender, it is important that these measures are critically screened for fit across content, context, culture and contemporality. Additionally, using existing gender measures regarding roles and norms risks reproducing stereotypical views and undesirable biases related to gender. It requires a conscious effort on the part of the researchers to avoid essentialist conclusions that perpetuate these stereotypes and reinforce stigmatization of participants who do not conform to traditional gender roles. Employing a multidimensional approach to gender acknowledges the complex and diverse nature of gender and helps to contextualize research findings by enabling analyses for both between group and within group similarities and differences. For this purpose, integrating social theory in analysis on how gender is situationally performed and using inclusive language in scientific writing is
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