Created by: Heather M. Truog, OTD, OTR/L, PYT
capstone project for post-professional doctoral program
University of St. Augustine for Health Sciences
A NATIONAL AGENDA FOR IMPROVING WOMEN’S HEALTH
A BRIEF HISTORY ON THE EVOLUTION OF THE U.S. WOMEN'S HEALTH AGENDA
The area of women’s health has been subject to significant growth within our healthcare model over the past fifty years. While much progress has been made within the United States to better serve the health needs of women, the continued need for improved research and effective interventions remain necessary. As larger bodies of influence such as the World Health Organization (WHO) have drawn increased awareness to the need for improved women’s health efforts, stating that “women’s health has become an urgent priority,” (WHO, 2009; as quoted by Davidson et al., 2011, p. 872) it has been advocated that “the health and well-being of communities and societies is dependent on the welfare, education, and empowerment of women” (Davidson et al., 2011, p. 874).
While much progress has been made to include and encompass the health priorities of women and women’s health research in the United States, much is yet to be accomplished. It was not until the last decades of the 20th century that a paradigm shift began to occur in the research efforts of women’s health, emphasizing a holistic perspective with increased attention to all aspects of health (Palmer & Sass, 2013). An effort to conduct women’s health research now reflects the conceptualization of a ‘life course approach,’ focusing on various life stages and events that affect overall presentations of health and wellness (Palmer & Sass, 2013). This emphasis on an expanded conceptualization urges researches beyond the biomedical focus of healthcare interventions and includes an increasingly wider body of research that depicts “the interplay, integration, and intersection of all aspects of life that affect health and well-being at the individual and population level” (Palmer & Sass, 2013, p. 114). This expansion encompasses perspectives from various social and psychological determinants of health, a shift that reflects an understanding of the greater influences and contexts in which identity and experiences impact health and wellness outcomes (Palmer & Sass, 2013).
Within the National Institutes of Health (NIH), the Office of Research on Women’s Health (ORWH) has an established research agenda titled A Vision for 2020 for Women’ Health Research: Moving into the Future with New Dimensions and Strategies (Pinn et al., 2010). This agenda outlines the organization’s outlook for scientific advancements in the field of women’s health research in the coming decade emphasizing research efforts through interdisciplinary and multidisciplinary collaboration (Pinn et al., 2010). The ORWH has since engaged various stakeholders encouraging an “environment for interactive discourse on future priorities and innovative scientific approaches to advancing the field of women’s health research” (Pinn et al., 2010, p. 1604). These priorities encompass a range of research topics beyond that of sex and gender in basic research findings, but also to include perspectives of “the impact of behavioral, psychosocial, and sociocultural factors on health and disease” (Pinn et al., 2010, p. 1604).
THE NEED FOR INTERDISCIPLINARY COLLABORATION
As the research objectives and goals of NIH and ORWH have evolved in the most recent decades, so too have the perspectives placed on the need for a collaborative body of interdisciplinary researchers to promote and enhance the study and execution of women’s health outcomes. Pinn and colleagues (2010) articulate the importance the ORWH has acknowledged in its need for public and professional partners to achieve its goals of improving health for the future generations of girls and women, families and communities, through the process of scientific investigation of all contributing parties. In the spirit of this collective effort to achieve optimal health outcomes for women across the lifespan, the onus is placed upon each professional domain to represent their disciplinary perspective through scientific research and peer-reviewed literature published in order to offer insight and expertise within their respective fields.
As the NIH and the ORWH expand upon their Vision for 2020, they have articulated their ongoing efforts to grow beyond their initially stated platform as they “continue to find that sex and gender influences on health pervade all disciplines of medicine” (NIH, 2019). The 2019-2023 Trans-NIH Strategic Plan for Women’s Health Research lists ‘Research’ as their number one strategic goal, specifically “to advance rigorous research that is relevant to the health of women” (NIH, 2019, p. 12). How to achieve this goal is articulated in five objectives (NIH, 2019, p. 13):
1). Discover basic biological differences between females and males.
2). Investigate the influences of sex and gender on disease prevention, presentation, management, and outcomes.
3). Identify the immediate, mid-, and long-term effects of exposure on health disease outcomes.
4). Promote research that explores the influence of sex and gender on the connection between mind and body, and its impact on health and disease.
5). Expand research on female-specific conditions and diseases, including reproductive stages, and maternal and gynecological health.
A CALL TO ACTION FOR OT PROVIDERS
To achieve the multifaceted goals of improving women’s health outcomes on both a global and a national level, an interdisciplinary approach must be utilized to expound upon all aspects and components of health perception, personal factors, environmental contexts, and elements of wellbeing. While other disciplines have endeavored to embrace specific research efforts towards women’s health improvement, the field of occupational therapy has yet to comprise an articulate representation of focus specific to the needs and considerations of this population. A lack of synthesized research pertaining to the occupational perspective relevant to women’s health topics leaves occupational therapists practicing in this field to draw upon tenants from other professional domains, or to overlook their role and potential for positive impact on quality of life outcomes altogether.
The lack of evidence-based research pertaining to women’s health topics within the domain of occupational therapy points of a significant gap in the research efforts of the profession. Women’s health topics that are relevant to the Occupational Therapy Practice Framework: Domain and Process (OTPF; AOTA, 2014) represent a wide variety of physical and psychosocial conditions, each with unique considerations relevant to client factors, performance skills, performance patterns, context, and environment. This makes the occupational therapist uniquely qualified to create a client-centered and holistic intervention method from an occupation-focused model of care. Without research efforts to contribute occupational therapy’s professional voice and perspective to the conversation about women’s health advancement, our professional credibility will be diminished as a healthcare science with a rich knowledge base to promote health and wellness within this client population.
Occupational therapists require research and literature that speaks directly to their domain of practice, placing the women’s health topics in question into the occupational perspective so that they may better understand the value of the role in which they play to achieve optimal health outcomes for the women they care for. The AOTA (2017) states their Vision 2025 as “occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living” (p. 1). It is the hope of this author that this stated vision should be achieved through an increased inclusion of an emphasis on women’s health topics within the designated occupational literature.
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.
American Occupational Therapy Association. (2017). Vision 2025. American Journal of Occupational Therapy, 71, 7103420010. https://doi.org/10.5014/ajot.2017.713002
Davidson, P. M., McGrath, S. J., Meleis, A. I., Stern, P., DiGiacomo, M., Dharmendra, T., … Anderson, D. (2011). The health of women and girls determines the health and well- being of our modern world: A white paper from the International Council on Women’s Health Issues. Health Care for Women International, 32(10), 870–886. https://doi-org.prx-usa.lirn.net/10.1080/07399332.2011.603872
National Institute of Health. (2019). The 2019-2023 trans-NIH strategic plan for women’s health research. Retrieved from https://orwh.od.nih.gov/sites/orwh/files/docs/ORWH_Strategic_Plan_2019_02_21_19_V 2_508C.pdf \
Palmer, J. R., & Sass, S. (2013). Chapter 8: Progress in women’s health research. Women and Health, 107–117. https://doi.org/10.1016/B978-0-12-384978-6.00008-X
Pinn V. W., Clayton J.A., Begg L., & Sass S. E. (2010). Public partnerships for a vision for women’s health research in 2020. Journal of Women’s Health (15409996), 19(9), 1603– 1607. https://doi.org/10.1089/jwh.2010.2386