Table 4.
Mapping facilitators and barriers to the Theoretical Domains Framework (TDF) with illustrative quotes and frequencies
| TDF domain | Facilitator/barrier | Illustrative quotes* | Frequencies† (N=4 groups) |
| Skills | The health professional acknowledges different treatment methods by gender (facilitator) | ‘Dominique, is that a man or a woman? … Because they are probably not treated the same’ (GD4) | 4 |
| The health professional acknowledges different clinical representation by gender (facilitator) | ‘…I work as a nurse in cardiac and pulmonary rehabilitation, and … it is a fact, that women come less [to rehabilitation programs] in general than men. Women often will quit [rehabilitation] or they won’t come because they’re taking care of everyone. But something happens [illness] and then they don’t have time to take care of themselves, because it’s too much’ (GD3) | 1 | |
| The health professional made assumptions about the gender of the patient when analysing a clinical vignette (barrier) | ‘I assumed that it was a guy’ (GD3) / ‘I presumed that it was a girl’ (GD4) | 3 | |
| Beliefs about capabilities | The health professional feels he/she can accurately observe the phenotype of the patient (facilitator) | ‘At the first contact we have with a patient … we see the phenotype there without talking about gender, it’s one of the things that jumps out at you when you’re taking notes.’ (GD3) | 3 |
| Social influences | The health professionals assume the patient’s gender based on his/her societal role (barrier) | ‘I heard ‘civil servant’, I don’t know, in my head I was like ‘civil servant’, so it’s a man.’ (GD4) | 3 |
| Knowledge | The health professional knows the differences between sex and gender in scientific literature (facilitator) | ‘Yes, that’s it actually, the biological aspect you certainly take into account in the study, but we are talking about the [social] categories of sex and gender… And menopause, and on the other hand [there’s] also andropause’ (GD2) | 2 |
| The health professional did not ask the gender of the patient when analysing a clinical vignette (barrier) | ‘Well, I don’t know why we didn’t note it [the gender of the patient], I don’t have the answer to that. But … when we talk about the clinical context it is systemically noted in the first … sentence, in the first two words (of notes documenting a consultation]. It’s hard to say that we ignore it [gender of the patient]. We didn’t notice it here, but in clinical practice, have you ever met a patient without identifying their gender?’ (GD3) | 2 | |
| The health professional is not aware of the concepts of sex and gender when analysing a clinical vignette (barrier) | ‘…but in the seminar, there was no emphasis on that, so it didn’t jump out at us,’ (GD3) | 1 | |
| Beliefs about consequences | The health professional mentions that they would not change their therapeutic approach according to the patient’s gender (barrier) | ‘I would say that I didn’t see the need to know if it was a man or a woman…I never asked myself the question…’ (GD1) | 2 |
| Environmental context and resources | The patient’s sex is routinely recorded in medical notes (facilitator) | ‘…in the clinical context it’s [the sex of the patient] systematically noted in the first lines in every consultation. In the first sentence, in the first two words. It’s hard to say that we ignore it.’ (GD3) | 2 |
| The androcentric nature of the French language (the use of masculine generic language to refer to men and women, as well as other gender representation) (barrier) | ‘In French everything is masculine until you know, like in the room here [mostly women participants] we’ll say like “ils ont fait ça” [ils is a masculine pronoun] because you are the only men, but…’ [generalizing to the masculine pronoun] (GD3) / ‘The language doesn’t help … [to differentiate between men and women].’ (GD3) | 1 | |
| The healthcare professional perceives that the language used by physicians towards a patient may be different according to sex and gender (barrier) | ‘Well it’s about when you say ‘our diabetes’ and ‘your depression’, if it had been a woman would we have said the same thing?…‘your depression’ ‘our diabetes’…’ (GD2) [referring to the bias in the language to describe ‘your’ depression versus ‘our’ diabetes] |
1 | |
| Social/professional role and identity | The health professional reflects positively on his/her relationship with the patient (facilitator) | ‘I work in an exclusively white environment, and I am the only black person, and I have no problem whether [the patient] is male, female or a child’ (GD3) | 1 |
| Intentions | The health professional has the intention to change his/her therapeutic approach by considering the differences of gender (facilitator) | ‘With the information that I have here [clinical description of vignette], if I had ‘menopaused woman’, then I think I would have researched more, but with what I had here, I didn’t [see the need].’ (GD4) | 1 |
| The health professional does not have the intention to change his/her therapeutic approach by considering the differences of gender (barrier) | “With what I have here [descriptive information of the clinical vignette], I am not sure to what extent I would have changed my approach’ (GD4) | 1 | |
| Goals | The health professional does not perceive the integration of the concepts of sex and gender in clinical practice as a priority (barrier) | ‘It wasn’t important … the most important, [but] that doesn’t mean that [the lack of sex and gender consideration in the clinical vignette] wasn’t perceived” (GD4) | 1 |
| Memory, attention and decision processes | The health professional does not consider that sex and gender are necessary parts of the decision-making process (barrier) | ‘If it is not obvious, we are not inclined to do it… [take into consideration the sex and gender of the patient]’ (GD2) | 1 |
*Free translation from French.
†The number of times that the barrier/facilitator appeared in the transcript.
GD, group discussion.