About Us - Background

Integration of Biobehavioral and Sociocultural Dimensions of Health

Since the landmark report by the Task Force on Women's Health in the mid- 1980s there have been a number of important efforts to enhance research in areas important to the health of women. Women's health research has been defined within the NIH as a scientific emphasis on "those diseases, disorders, and conditions that are unique to, more prevalent among, or more serious in women, or for which there are different risk factors or interventions for women than for men" (U.S.Public Health Service, 1992). Further expansion of this definition is provided by the definition used in the recent survey of Women's Health in Baccalaureate Nursing Curriculum: "women's health refers to health and illness issues that are unique to or more prevalent influence therapeutic choices is essential to advancing the science of women's health. Moreover, selection of appropriate research methods from a variety of disciplines is valuable in pursuing studies that involve consideration of heterogeneous populations in which sex, gender and ethnicity influence health dimensions ranging from perceived health to mortality (Mazure, Espeland, M Douglas, Champion, & Killien, , 2000). Reviews of women's health research in nursing and other disciplines have focused on the need to move beyond description of women's health and ethnic or racial disparities to the development and testing of interventions to improve women's health and reduce disparities (Taylor & Woods., 2001; Flaskerud, al., 2002). The complexity of such efforts will require that nurse scientists develop capabilities in interdisciplinary collaboration.

Future Challenges for Women's Health Nurse Scientists.

The National Institute for Nursing Research has supported a wide range of women's health research, with its efforts predating the initial Hunt Valley agenda. Reviews of nursing research focusing on women's health have illustrated the significant contribution of nursing research to women's health scholarship (Tavlor & Woods., 2001). In the past decade nursing research has expanded both substantively and methodologically. Nursing research expanded by using holistic and biopsychosocial frameworks, incorporating women's lived experiences and feminist perspectives, and using multiple and complex designs to generate knowledge not just about women, but for women. Increasingly nursing research is moving beyond description and beginning to develop and test interventions to improve women's health (Taylor & Woods, 2001).Yet, despite the recent emphasis on and increase in funding for women's health research, disparities in the health of women remain. Future challenges for women's health researchers include: 1) extending and integrating knowledge of biobehavioral and sociocultural dimensions of women's health, with an emphasis on sex- and gender-differences and advances in genetics, 2) expanding understanding the etiology of and means to reduce health disparities among vulnerable sub-populations of women, and 3) advancing interdisciplinary and collaborative efforts to test interventions to promote, maintain, and restore women's health. These challenges are addressed in this proposed women's health nursing research training program.

WOMEN'S HEALTH NURSING RESEARCH AT THE UNIVERSITY OF WASHINGTON

The University of Washington provides a unique institutional environment for the WHNRTG. For over 25 years the University of Washington has ranked among the top 5 universities nationally in receipt of federal grants, including Nationals Institutes and National Science Foundation. The University of Washington is the largest recipient of federal research funds of all public universities. Nearly half of extramural research funding is from the U.S. Department of Health and Human Services.

Women's health research at the University of Washington School of Nursing (UWSON) has, for the past two decades, emphasized women's health-related experiences in relation to biobehavioral dimensions of health and their sociocultural environments, and therapeutic processes to assist women in promoting, maintaining, and regaining their health.

The University of Washington (UW) has a rich history in the area of women's health research as well as a tradition of interdisciplinary collaboration among the scientists in health sciences and other departments. Funding for predoctoral and postdoctoral training in women's health research (WHNRTG), T32-NRO7039, was first awarded to the UW School of Nursing in 1997, initiated and led by Dr. Nancy Woods (Core faculty). The UW School of Nursing is also home to the first NIH funded center focused on women's health research, the Center for Women's Health Research (CWHR), P30 NR04001, which was also initiated and led by DrWoods and is currently led by Dr. Margaret Heitkemper (Co-director) and Dr. Marcia Killien (PI and Director). The CWHR supports core biobehavioral and immune laboratories, consultation on methods to study diverse populations of women, data management and analysis services, and pilot projects. In 1998 the or serious in women, have causes or manifestations specific to women, and occur across the life-span and within the context of women's lives. Such context includes but is not limited to environment, social status, economic class, political belief and /or affiliation, ethnicity, cultural background, developmental state, biologic and/or genetic makeup, and spirituality" (Department of Health and Human Services, 2000).

Efforts such as the Hunt Valley reports, in which key areas for women's health were identified, have helped focus research activities in the area of women's health. The OWHR's women's health research agenda for the twenty-first century emphasized cardiovascular disease, neuroscience and behavior, immunology/growth and development, infectious diseases, mental and addictive disorders, reproductive health, and cancer. In addition, special issues related to conducting research with women were explored, including: cross--disciplinary collaboration, involvement of and benefit of research to diverse communities, need for longitudinal studies to understand lifespan issues, inclusion of women in clinical trials, need for noninvasive or minimally invasive markers for endocrine studies, and new approaches to conducting clinical research. Preparing women for scientific careers also received special emphasis (National Institutes of Health, 1999).

Understanding how women mediate their sociocultural environments remains an important but poorly understood aspect of women's health. Key to understanding the consequences of symptom management interventions is characterizing these interactions in women across the lifespan and those with a variety of health problems. Analysis of environments as sociocultural, political and economic worlds that influence women's health has become an important aspect of contemporary inquiry.

Health Disparities among Subpopulations of Women

American women come from and live in diverse racial, ethnic, cultural, and socioeconomic environments. Women's health research has focused on understanding the experiences unique to special groups of women. "Special populations" of women includes those of different racial, ethnic, and cultural origins, women with disabilities, lesbians, women living in urban and rural settings, and immigrants, among others (Sarto, 1999). In addition, the changing needs and vulnerabilities of women over the course of the life span must be considered, with women in different life stages and ages experiencing different life contexts. A woman's health status may depend on the group or subgroups to which she belongs. Literature in the fields of women's health and women's studies increasingly indicates the importance of studying women as diverse rather than monolithic populations (Cain & Rodriquez-Trias, 1999).

Some groups of women experience great disparities in their health and health care; the elimination of health disparities one of the top priorities of the nation and is among the major challenges for contemporary scientists. (U.S. Department of Health and Human Services, 1990) (National Women's Law Center, 2001). Among those populations considered vulnerable to health disparities are the 40 million women of racial and ethnic minorities whose percent of the total American women totals 29% (Satcher, 2001). These populations are growing as evidenced by the US Census Bureau estimates, and as these proportions of minority women grow, so do the years that they will live. These women will face health disparities that are of particular risk to women of color and to women over the age of 65. Satcher (2001) cautioned not to assume we understand a particular population's health status until we study the problem closely.

How has nursing responded to the development of the science related to health disparities? Flaskerud, et al (2002) reviewed publications in Nursing Research during the past 50 years to analyze the nursing contribution to the body of knowledge in health disparities. The authors found 79 papers that related to the study of health disparities. The majority of these papers have been published since 1990. Nursing has tended to focus on the psychosocial risk factors associated with health disparities, social justice, symptom management and a beginning in intervention studies. These authors recommend that the next phase of nursing research related to health disparities should begin to focus on community models and intervention studies that impact socioeconomic and health care outcomes.

Differences in health status and outcomes among different populations are known to correlate with educational, cultural, social and behavioral variables as well as availability of and access to services, differences in treatment, and differences in supplementary services. However physiological differences may also be a factor in determining outcomes. It is insufficient to assume that a finding of differences in health outcomes associate with ethnicity is due to either physiological or sociocultural variables without a more complex genetic research approach. It is also possible that differences rest not within the individual, but with health care providers who may provide care differentially to women of different ethnicities based on provider attitudes, behaviors and cultural differences (Society for the Advancement of Women's Health Research, 1997).

Development and use of methods and measures appropriate for and sensitive to socially and culturally diverse populations of women is a priority in both quantitative and qualitative approaches to expanding knowledge of women's health. Women's health research values personal experience and this requires more sophisticated methodologies that are able to combine an interpretive and phenomenological paradigm with new quantitative and physiologic measures in order to contextualize women's health. As stated by Krause in his challenge to AIDS researchers, "the social and behavioral sciences and the natural sciences must form a new union in which the sum is greater than the parts" (Krause, 1996). Methodological considerations include selecting a study design, including recruitment and retention strategies, that invites inclusion of diverse groups of women as well as selection of measurement approaches that adequately represent their experiences. Consideration of the complexity of women's diversity needs to be present during data analysis and interpretation. It is insufficient to merely recruit women from diverse groups as study participants without considering the adequacy of study design, measures, and analysis to represent their experiences. The challenge is to generate and refine methods that are able to capture the variation across social/economic/cultural/life span differences while identifying commonalities (Killien,et al., 2000).

Interdisciplinary Collaborations to Test Interventions

The breadth and complexity of the science of women's health, including the effects of sex and gender, ethnicity, and age on health, requires expertise in fields of study that transcend disciplinary boundaries. Inclusion of biological, behavioral, sociocultural, and environmental variables as they affect health and development of a National Center of Excellence in Women's Health (CoE) at the UW (RFP 213-98-0009) with Dr. Emily Wong as PI and Director and Dr. Killien as Co-director was funded. These previously funded awards have fostered publications in the women's health literature, served as a catalyst for collaboration among faculty and graduate students concerned about women's health, and stimulated research efforts among faculty and trainees. In addition, the collaborative interdisciplinary relationships fostered by the WHNRTG supported the applications for the CWHR and the CoE, and these centers, in turn, have enriched our training environment and resources for predoctoral and postdoctoral trainees.

University of Washington School of Nursing