Gender and assistive technology; A scoping review protocol
Creators: name: Austin, Victoria
name: Guinness, Elizabeth Mc
name: Dilisha Patel
Publisher: name: OSF Registries
Year: 2023
Subjects: subject: Health Information Technology
subject: Occupational and Environmental Health Nursing
subject: Disability and Equity in Education
subject: Computer Engineering
subject: Women's Health
subject: Public Health
subject: Medicine and Health Sciences
subject: Arts and Humanities
subject: Occupational Health and Industrial Hygiene
subject: Education
subject: Gender and Sexuality
subject: International Public Health
subject: Public Health and Community Nursing
subject: Robotics
subject: Mental and Social Health
subject: Community Health
subject: Social and Behavioral Sciences
subject: Sociology
subject: FOS: Sociology
subject: Nursing
subject: FOS: Health sciences
subject: Engineering
subject: Health Services Research
subject: Biomedical Engineering and Bioengineering
subject: Gender Equity in Education
subject: Assistive Products
subject: Assistive Technology
subject: Disability

description: A higher prevalence of disability has been found among women, compared to men.(Lee, Meijer et al. 2020) For example, the World Report on Disability found the global prevalence of any form of disability was found to be 7% higher for women than men, at 19.2% and 12% respectively.(Bickenbach 2011) In low- and middle-income countries, women are estimated to make up three-thirds of person living with disabilities. This is thought to relate to an interplay of biological and socio-demographic factors, including life expectancy, gender inequality and exposure to violence.(Leveille, Resnick and Balfour 2000) Despite higher prevalence of disability among women and girls, data shows that women are less likely to access assistive technology (AT)1 as compared to men.(Rintala 2002, World-Health-Organization 2022) According to data collected across thirty-five countries, using the WHO rapid assistive technology assessment (rATA) questionnaire, female respondents reported higher prevalence of need for AT compared to male respondents in the majority of countries surveyed. Conversely, male respondents reported higher levels of access to AT in most countries, with disparities increasing within countries with lower human development (HDI) index scores.(World-Health-Organization 2022) The disparity in prevalence in AT access among women and girls may be attributed to socio-cultural norms surrounding gender, which give rise to inequalities in terms of access to financial, and other household resources, education, and healthcare, among others.(World-Health-Organization 2022) Both gender and sex are to be understood according to the Sex and Gender Equity in Research Guidelines.2 (Heidari, Babor et al. 2016)Such disparities cannot be divorced from wider legacies of sex and/gender biases which have been well documented within research involving human subjects, from fields to (biomedical) engineering, to (psycho)pharmacology.(Geller, Koch et al. 2011),(Kim and Menon 2009, Coen and Banister 2012, Franconi and Campesi 2014),(Cirillo, Catuara-Solarz et al. 2020) In the discipline of engineering for example, failure to consider physiological differences in male and female anatomy in design and testing of seatbelts is thought to have contributed to higher risk of whip-lash injury for female drivers and passengers, compared to males.(Jakobsson, Norin and Svensson 2004, Linder, Schick et al. 2013) Less is known, in comparison, about how biases surrounding physiological differences play-out in design of assistive products, although the implications, including potential injury, are no less salient. The legacies of sex and gender biases within health service provision, including diagnostics and treatment, and particularly in pain management are equally well documented.(Hirsh, Hollingshead et al. 2014, Clerc Liaudat, Vaucher et al. 2018, Wolfe, Walitt et al. 2018, Garb 2021) The implications of sex and gender biases within service provision for assistive technology, however, remain in need of unpicking. In addition to access, gendered differences have also been reported in relation to acceptance of AT, which may in turn relate to acceptance among families, and communities, including in association with disability-related stigma.(Rintala 2002, Parette and Scherer 2004) Use of assistive products may make disabilities (more) ‘visible,’ and indeed adoption, usage and abandonment can hinge upon users’ and families’ willingness to ‘take-on’ risks associated with higher visibility, which are in turn produced and re-produced at micro-and-macro levels.(dos Santos, Ferrari et al. 2022) The (re)production of gendered scripts in the design process of AT has also been documented.(Resnik, Klinger et al. 2019) For example, adaption of aesthetics based on user' preferences, which themselves may be both influenced by and reify norms associated with masculinity or femininity, have emerged as salient towards acceptance and use of AT. For example, in relation to prosthesis, recent studies found that gender demonstrated a significant predictor for rejection, with more women than men exhibiting rejection of devices.(Biddiss and Chau 2008, Kyberd and Hill 2011, Østlie, Lesjø et al. 2012) In exploring the role of aesthetics in acceptance of the DEKA arm (an upper limb prosthetic) among women with upper limb amputation, Resnik et. al. call for the “appropriate gendered” appearances and designs of devices.(Resnik, Klinger et al. 2019) This leaves gaps in understanding of what constitutes “appropriate gendering” of prosthesis, or indeed other assistive devices, for users who transgress gender binaries, or those whose gender identities do not align with those assigned to them at birth, and may, depending on setting, finance, and other factors, lack access to avenues to acquire gender-affirming devices. Lack of access and acceptance of AT contributes to a cycle of exclusion for women and girls, as well as those and others among gender minorities, with disabilities.(Austin, Holloway et al. 2021) To bridge gendered inequalities regarding AT, it is first necessary to map evidence surrounding the role of sex and gender on AT. An objective of this review is therefore to explore how sex and gender (as a sociocultural construct) may shape access, acceptance, use, and outcomes of AT. In doing so, it seeks to identify the facilitators and barriers to the above to outcomes among cisgender women and girls, and if existing data, gender minorities. Preliminary searches with OVID, the Cochrane Database of Systematic Reviews, and Google Scholar were conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. To the authors knowledge, this shall represent the first scoping review to systematically identify and synthesise evidence surrounding the role of gender in AT. A scoping review is appropriate given the broad interest in the proposed subject matter and relative novelty/sparseness of the evidence-base, combined with the overarching aim to identify gaps within. (Munn, Peters et al. 2018) Identification of facilitators and barriers shall support design of interventions to lessen the gender divide in relation to AT. It is hypothesised that this shall in turn contribute to enhanced health and other outcomes, including participation for older women and girls, and gender minorities, or those living with disabilities. Improving access to AT across social determinants is recognized as a recommendation within WHO’s Global Report on Assistive Technology (GReAT), as well as being integral to achievement of the Sustainable Development Goals (SDGs), and realization of the Convention of the Rights of Persons with Disabilities (CRPD).(World-Health-Organization 2022) Finally, extracting data related to adaptions made to research protocols, toward gender and disability inclusion, shall scaffold work toward increased equity in epistemologies of AT. (Heidari, Babor et al. 2016)