Chapter 4 90 on the illness experiences of men and women with PD. Other social identities besides gender, such as their illness or disability identity, or more specifically a ‘Parkinsonian identity’26, was also cued in the interviews and likely to be more salient than gender for these participants.27 It remains to be investigated how the salience of gender related aspects in illness experiences might differ in various social groups of people with PD when viewed from an intersectional perspective.28 Rohmer et al (2009) conducted an intersectional study into the salience of disability, gender and ethnicity and concluded that disability could be considered a superordinate social category, especially when disabilities are visible.11 In line with other studies, these findings support the hypothesis that particularly visible and chronic disabilities are predominant as a salient characteristic in a person’s identity management.29 Earlier studies on the impact of PD on identity management echo the challenge of maintaining, renegotiating and developing new ‘senses of selves’ and relationships with others as the disease progresses. Being able to effectively cope with this process is essential for the well-being of people with PD.3,30,31 Healthcare professionals should be aware that in people with PD whose gender identity is highly salient, the adaptability in identity management and the development of effective coping strategies is influenced by self-stereotyping behaviours. They are also more likely to conform to social pressures communicated through gendered norms, regardless of whether these behaviours are harmful or beneficial to their physical or mental health. Cultivating competence in healthcare professionals to be able to notice contextual ‘red flags’ regarding harmful gendered norms or behaviours that could complicate care is central to the practice of gender-sensitive care for people with PD.32 Clinical considerations Providing gender sensitive and contextualized Parkinson care requires an awareness of what to look for. Contextual red flags can include something that a patient says, an observation of the individual situation of the patient, or behaviour that suggests unaddressed contextual factors might be contributing to problems with their care.33 We observed some clinically relevant contextual flags related to gender that could contribute to problems with care of people with PD in this study. For example, one man in our study expressed “the strange sensation” of renegotiating self-stereotypical behaviours which he had practiced all his life related to a gender norm of ‘men don’t cry’ [Interview 32]. This is an illustration of how non-motor symptoms (increased emotionality) activate restrictive gender norms related to emotional coping in this patient. Probing further during a medical consultation could reveal that this non-motor symptom is ineffectively coped with due to restrictive self-stereotyping behaviours (i.e. the contextual factor). Once the contextual factor is revealed, it can open avenues
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