Chapter 3 58 Discussion We conducted the present study to explore the impact of the different gender dimensions - gender identity, gender role orientation and gender relations - on health-related quality of life (HRQoL) among people with Parkinson’s disease (PD). We found no significant association between self-reported gender identity and overall HRQoL, whereas an androgynous gender role orientation and higher engagement in household tasks (gender relations in the private domain) were each associated with better overall HRQoL among people with PD. These results highlight the need to specifically define and operationalize the gender dimensions under investigation to aid the clinical implementation of gender-sensitive results in the care of people with PD. The impact of gender on clinical outcomes has been postulated in other fields31,32,however, the use of composite indices rather than the investigation of specific gender dimensions limits the transferability of these findings into clinical practice. We recently demonstrated the impact of gender roles on HRQoL in longterm cancer survivors and their relative underestimation in men with cancer.33 These results were only possible when disentangling the gender identity dimension from gender roles.34 Although most current research focuses on gender identity, other dimensions such as gender roles, norms and behaviours probably impact health behaviour and illness more significantly. Our present study supports this assumption and offers the first detailed description of the impact of different gender dimensions on the QoL of people with PD. In fact, in our population gender identity did not impact overall HRQoL, yet an androgynous gender role orientation (GRO) associated with better overall HRQoL. This particular finding is in line with previous reports outlining the importance of gender roles in PD.35–37 Overall, these findings build on the Sex Role Adaptability hypothesis stating that psychologically androgynous individuals are more flexible in their choice of situationally effective behaviours and can, hence, better adapt to varying challenges.38 Psychosocial and behavioural interventions hold great promise as non-pharmacological approaches for managing a variety of motor and non-motor symptoms in PD, particularly in reducing stress, anxiety and depression; all of which impact HRQoL.39,40 Psychosocial interventions aiming to improve HRQoL of people with PD could strengthen a persons’ practice of supportive gender-related traits to cope with the evolving reality of a chronic disease and its impact on quality of life, while remaining attentive to their sociocultural normative aspects.
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