Gender research about medical services
FYI, my letter to Prof Crampton whose interview with Radio NZ showed some fine feminist reasoning (find it at http://www.radionz.co.nz/national/programmes/afternoons/20120704)
I also sent a letter summarizing my concerns to the editor of the journal, who happens to be Professor Felicity Goodyear-Smith!
MINISTRY OF MEN’S AFFAIRS
MINITATANGA MO NGA TANE
PO Box 13130,
(07)5712435 or (0274)799745
5 July 2012
Professor Peter Crampton
Health Sciences Division
University of Otago
PO Box 56
Dear Professor Crampton
Re your study: Gender differences in financial barriers to primary health care in New Zealand. Journal of Primary Health Care 2012; 4(2): 113-122
We are concerned that this study, media reports and your interviews about it have added unjustifiably to fashionable stereotypes about women’s disadvantage and men’s irrelevance. We are concerned at implied calls that more financial assistance should be provided for women to purchase medical services at the expense of available funding for men.
The main finding of your research was based on self-report. Self-report is known to be a poor indicator of real behaviour because of factors such as social bias influencing subjects’ responses (e.g. van de Mortel, 2008). In addition, there was no indication of the reliability or validity of the specific self-report instrument your study used. While your study acknowledged threats to the validity and reliability of its self-report data, your wording and public reporting on the study ignored this problem and portrayed the data as representing real behaviour as opposed to self-report about behaviour.
We believe that, in line with popular ideology, many women responding to your questions will believe they are disadvantaged relative to men including financially, and will believe that women need a lot more in order to gain equality. Comments in your paper showed that the researchers approached the study with similar kinds of beliefs. Aside from any interviewer demand characteristics, such beliefs can be expected to have influenced your female subjects’ responses. For example, they might incorrectly recall historical deferrals as if they occurred in the last 12 months and/or attribute any deferrals to financial deprivation whether or not that was actually a significant factor. On the other hand, men may also have felt too poor when actually faced with purchasing medical services but later resisted acknowledging this reason (even to themselves) because that would imply they were inadequate in their role as primary earner for their family. The relationship between the self-reported attributions and the subjects’ real situations was unclear and not investigated.
Further, some or many of your subjects may well have taken the opportunity to support women’s cause generally. The questions asked were leading and each subject will have recognized immediately an opportunity to treat the research as advocacy research for all those women she believes are struggling financially, regardless of whether that subject herself had any real financial constraint on being able to purchase the medical service. In the absence of any hard data about actual behaviour, little can be safely concluded from this form of research.
Wording throughout your paper compounded the problem. Sometimes it referred to the actual findings, e.g. in the first paragraph of “Results’ it stated “The results show that women were more likely to report that they had deferred seeing their doctor(s), dentist or collecting a prescription at least once during the preceding 12 months because they could not afford the cost”¦”. However, from the very next sentence and generally throughout the paper this finding was misrepresented as “”¦women were more likely to defer a doctor’s visit”¦” etc. The fact is that we don’t know that any woman actually deferred any such purchase due to financial constraint and your paper should not have misled the public on that matter.
Your comments in Radio NZ interviews (04/07/12) further added to the misrepresentation, firstly by using wording suggesting the study represented actual behaviour as opposed to self-reported claims, and secondly by suggesting explanations for your “finding’ based on ideological beliefs about women bravely juggling more responsibilities than men, having less money and tending to choose to prioritise expenditure on their children over their own medical purchases. Such explanations may well apply to some (unknown) extent but they could equally apply to men, while other explanations such as women’s choice to spend their money on hairstyles, new shoes or pokie machines will also apply to some (unknown) extent. Moreover, you referred to men’s (better substantiated) tendency to defer medical visits etc as being “about the way we construct maleness in NZ” and “learned behaviour”. By making these comments and avoiding any acknowledgement that men’s lower medical purchases could also be related to their self-sacrifice you implicitly supported a fashionably misandrist view of men being bozos driven by machismo.
Another fundamental challenge to your research conclusions related to the likelihood that women vs men would purchase medical services at all. We know that women are more likely to purchase medical services generally, so they will have more opportunity to defer, or to recall deferring, such purchases. Further, if women are more likely to purchase medical services for less serious concerns, they can be expected more often than men to decide that following through with prescriptions or return visits should not be prioritised financially. Those less-serious symptoms are more likely to appear to be resolving naturally by the time of the appointment or planned expenditure, and/or they will be more likely to have been resolved by the placebo effect from any medical contact the woman made. Without controlling for the seriousness of symptoms, no conclusion is justified suggesting that women’s alleged deferrals comprise a significant problem.
We appreciate that your research and comments about it were motivated by the best intentions, and that the male-denigrating impact you have had was unintentional. However, we urge you in future to take much more care in representing your research findings accurately and in considering more carefully the gender implications of your statements.
The Ministry of Men’s Affairs is a community initiative because successive governments have failed to provide for men’s welfare.
Van de Mortel T F (2008). Faking it: social desirability response bias in self-report research. Australian Journal of Advanced Nursing; 2008; 25(4); 40-48