Multiple Gender Dimensions 47 3 Methods Study design We conducted a cross-sectional survey study among persons with PD living in the Netherlands. We recruited the participants between March 2020 and March 2021 as part of a large prospective cohort study; the PRIME Parkinson Evaluation Study (PRIME-NL Study).19 The PRIME-NL Study has been approved by the Ethical Board of the Radboud University Medical Centre (CMO file number 2019-5618). All participants signed a digital informed consent before inclusion in the study. Study population Participants were eligible for this study if they met the following criteria: Diagnosed with Parkinson’s disease or Parkinsonism; 18 years of age or older; Able to read and understand Dutch; Willing and able to complete an online survey; Providing digital written informed consent. Clinical assessments The following demographic and clinical data were recorded: age, disease duration, years living with symptoms, clinical disease duration, and education level. Health-related quality of life We used the Parkinson Disease Questionnaire (PDQ-39), a disease-specific, a selfevaluative health-related quality of life (HRQoL) instrument, to assess HRQoL. Participants are asked to score each of the 39 items on a 5-point Likert scale from 0 (never) to 4 (always). Followingly, we calculated the eight subscale scores and an index summary score (PDQ-SI), with all answers being transformed to a 0–100 scale and higher scores representing worse HRQoL. The eight PDQ-39 subscales are mobility (MOB), activities of daily living (ADL), emotional well-being (EMO), stigma (STIG), social support (SOC), cognitive impairment (COG), communication (COM), and bodily discomfort (BOD). Gender dimensions assessments To capture multiple gender dimensions in our survey, we performed a literature review to identify state-of-the-art options for operationalizing the gender dimensions applied to this study: Gender identity, gender roles and gender relations (Supplement 1). Gender identity The dimension of gender identity refers the gendered sense of self of a person.20 Gender identity was operationalized through self-reported gender identity, sex assigned at birth and sexual orientation. Self-reported gender identity refers to the self-identification of a
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