An educational intervention to promote a culture of gender equity among persons with traumatic brain injury and caregivers: A pilot study

Sara Hanafy; Enrico Quilico; Halina Lin Haag; Yuelee Ben Khoo; Sarah Munce; Sally Lindsay; Angela Colantonio; Tatyana Mollayeva

doi:10.3389/fresc.2023.1160850

An educational intervention to promote a culture of gender equity among persons with traumatic brain injury and caregivers: A pilot study

Front Rehabil Sci. 2023 Apr 26:4:1160850. doi: 10.3389/fresc.2023.1160850. eCollection 2023.

Authors

Sara Hanafy^{1

2

3}, Enrico Quilico¹, Halina Lin Haag⁴, Yuelee Ben Khoo^{2

5}, Sarah Munce^{1

2

6

7}, Sally Lindsay^{1

3

6}, Angela Colantonio^{1

2

5

5

6

5}, Tatyana Mollayeva^{1

2

5

6}

Affiliations

¹ Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
² KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
³ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
⁴ Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada.
⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Traumatic brain injury (TBI) outcomes are dependent on patients' biological sex (e.g., hormone levels) and sociocultural gender (e.g., norms, responsibilities). Informal caregivers additionally experience disruptions to identity and roles post-TBI. However, information on this topic remains largely unavailable to patients and caregivers.

Purpose: This study aimed to determine the effectiveness of a one-time educational intervention on sex and gender influences in TBI for patients and informal caregivers.

Materials and methods: We conducted a pilot pre-test/post-test randomized control-group design study. Groups (i.e., passive, active and control) consisted a total of 16 persons with TBI and caregivers (75% persons with TBI, 63% women). Individual and group learning gains, and group-average normalized gain, were computed for three learning domains: knowledge, attitude, and skill. An intervention with an average normalized gain of ≥30% was considered effective. Educational intervention evaluation and qualitative comments post-participation were summarized.

Results: The passive group demonstrated the highest average normalized gain across the three learning domains, including 100% for knowledge, 40% and 61% for attitude, and 37% for skill. The remaining groups did not reach an average normalized gain of ≥30%, except for the attitude domain of the control group (33% and 32%). Two key categories were identified qualitatively: (1) gendered self-expectations post-injury and (2) implications of gender stereotypes in rehabilitation, including the need for rehabilitation treatment to look beyond sex and gender. The post-participation educational session evaluation conveyed high appraisal of content, organization, and usability of the intervention.

Conclusion: A one-time passive educational intervention on sex and gender in TBI may improve knowledge, attitude, and skill on the topic of sex and gender among adults with TBI and caregivers. Obtaining knowledge and skill on sex and gender effects in TBI can potentially help persons with TBI and caregivers adapt to changes in roles and behaviours post-injury.

Keywords: biological sex; brain injuries; concussion; education; gender role; knowledge acquisition; rehabilitation.

Grants and funding

This study was supported by a research grant from the Canadian Institutes of Health Research (CIHR), Institute of Gender and Health (https://cihr-irsc.gc.ca/e/8673.html) (#CGW-126580) (AC), the CIHR and Social Sciences and Humanities Research Council (CIHR-SSHRC) Partnership Grant (SSHRC-895-2018-4002; CIHR-01561-000) (SL) and in part, thanks to funding from the Canada Research Chairs Program in Traumatic Brain Injury in Underserved Populations (CRC-2019-00019) (AC) and Canada Research Chair in Neurological Disorders and Brain Health (CRC-2021-00074) (TM). This work was also developed through liaising with brain injury stakeholders, including Ontario Neurotrauma Foundation and Brain Injury Canada. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.