Introduction

Sustainable actions to counter persistent health inequities require the participation of underrepresented, vulnerabilized, and marginalized groups in research-intervention projects and imply considering inequitable power relations, including those related to sex and gender (S/G). From an epistemic justice perspective, non-dominant groups can suffer from standpoint biases or deficit in credibility (Fricker, 2007). To minimize power imbalances between researchers and populations experiencing health inequities, various types of participatory research (PR) that integrate knowledge users from the beginning and throughout the research process, especially those that include an intervention, have been shown to yield better results in terms of knowledge translation, health outcomes, and equity (Cacari-Stone et al., 2014; Coombe et al., 2020; Ward et al., 2018). Community-based PR involves all partners, academic and non-academic, and is based on principles involving reflexive processes, capacity building, and reciprocal benefits (Israel et al., 2010; Jull et al., 2017; Wallerstein & Duran, 2010), aligning with principles of epistemic justice (Fricker, 2007). Integrated knowledge translation is a fundamental part of truly participatory processes by which interactive activities are employed to share knowledge throughout a project (CIHR, 2016a; Cornwall & Jewkes, 1995; Gagliardi et al., 2016; Jull et al., 2017).

Health inequities may result from various sociodemographic factors and their intersection (Collins, 2019; Crenshaw, 1989). This study is the result of a participatory, reflexive process involving academic and non-academic partners aimed at identifying guidelines to overcome the specific challenges that arise when taking into account S/G issues in PR.

When PR systematically takes into account S/G issues, by involving multiple subpopulations in initiatives that address their diverse needs, it can improve a project’s relevance and yield better outcomes in terms of sustainability and equity (Manandhar et al., 2018; Tannenbaum et al., 2016). Taking account of S/G issues in PR means considering power relations and normative social interactions among genders (women, non-binary, men) as they relate to macro-level structures, health behaviours, outcomes, access to health services, and people’s engagement with integrated knowledge translation activities. It also means using a “S/G lens” in the analysis of systemic factors, health situations, individual characteristics, exposures, and the impacts of changes, including mechanisms that lead to detrimental health outcomes, reinforce stereotypes, or exacerbate S/G inequities in health (Tannenbaum et al., 2016). In sum, considering S/G in health studies has been shown to favour improved conditions for women, men, non-binary people, and society in general (Messing, 2021; Spitzer, 2005).

For the past 40 years, a Canadian research centre, CINBIOSE, specializing in occupational (OH) and environmental health (EH), has been conducting participatory action research integrating knowledge translation and using a S/G lens, directed toward improving health and reducing social inequities (Mergler, 2012; Messing, 2014, 2021). One of these studies, in OH, investigated the impacts of 12 PR projects that used a variety of strategies to consider S/G differences in workplaces. The authors found that such strategies resulted in improved S/G equity at the macrosystem level (e.g. laws, regulations, policies) and at the workplace level (e.g. adapted tools, improved working conditions) (Laberge et al., 2020). Some approaches used under the umbrella of EH, such as ecosystem approaches to health, recognize the need both to collaborate with a broad array of stakeholders, especially those most impacted by health injustice(s), and to apply a gender and social equity lens (Webb et al., 2010).

Despite its potential to reduce health inequities, researchers have found that integrating S/G in PR projects is complex and sometimes challenging, for example, in reaching consensus with stakeholders and in accessing techniques for collaborative knowledge construction (Gagliardi et al., 2016). Taking account of S/G adds a layer of complexity and supplementary obstacles, inducing resistance on the part of some stakeholders, uncertainty about how to use the proposed S/G frameworks, and methodological limitations when taking into account S/G (Gogovor et al., 2020; Laberge et al., 2020). In participatory OH research, for instance, workers and employers may have opposing interests and different views on gender issues (Messing, 2021). In EH, participatory approaches that integrate social as well as gender equity have been developed and are increasingly called for but are not yet the norm, in part due to the complexity of issues being studied and a dearth of training (Berbés-Blázquez et al., 2014; Mertens et al., 2005). Taking account of S/G can sometimes lead to conflicts with stakeholders or threaten strategies employed to maintain partnerships (Gogovor et al., 2020).

Thus, integrating S/G into health-related PR and associated integrated knowledge translation activities requires specific skills to engage simultaneously with two inseparable processes: the partnership process and the research process. The two are equally important since they enhance partners’ capacity, promote reflexivity, contribute to building trust, encourage knowledge translation, yield better results, and, ultimately, have the potential to transform inequities and improve health and well-being (Bagnol et al., 2015; Friedson-Ridenour et al., 2019; Masuda et al., 2014; Ward et al., 2018). There are guidelines for successful partnership building in PR, providing recommendations on issues such as engagement, reflection on process and relationships, and collaboration (Drahota et al., 2016; Huang et al., 2018; Sarkies et al., 2017). There are also guidelines on how to consider S/G in research, from selecting theoretical approaches to collecting and analyzing data and planning end-of-grant knowledge translation activities (Day et al., 2017; Gendered Innovations, 2021; Hankivsky et al., 2018; Heidari et al., 2016; Morgan et al., 2016; Morgan et al., 2017; Tannenbaum et al., 2016; Tomás et al., 2015). However, having evolved separately, the literature is scant on guidelines combining S/G analysis and PR.

The present study is intended to produce a scoping review that provides an inventory and typology of existing guidelines for researchers on how to take account of S/G in the context of PR involving integrated knowledge translation and aimed at improving health, especially reducing health inequities. To our knowledge, it is the first time that such a typology of guidelines intended for researchers has been carried out on this subject.

Methods

As part of a participatory, inductive research design, this scoping review (Arksey & O’Malley, 2005; Pham et al., 2014) included studies from various subfields of public health (including OH and EH) and covering a wide range of designs and methodologies. Given the diversity of approaches, fields, and underlying conceptualizations covered, we built a typology through a mixed-method synthesis. The types emerged from a cluster analysis based on variables stemming from a qualitative analysis of the documents considered for this review. Each step of this project resulted from the combined efforts of a transdisciplinary advisory committee composed of academic and non-academic researchers as well as students from diverse public health domains and sociocultural/linguistic backgrounds. The participatory component of this project was collectively perceived as an essential reflection on our research processes. A total of 14 advisory committee meetings were held including workshops to identify main concepts; collective validation of analytical categories; and results interpretation, in addition to participation in several scientific conferences.

Literature search strategy

Broad concepts such as PR with integrated knowledge translation, S/G, and public health, with a focus on inequities, work, or environment, were searched in nine databases spanning a 20-year period (2000/01/01–2020/07/30; ABI INFORM, ERIC, GenderWatch, Sociological Abstracts, Medline, PsycINFO, GreenFILE, SCOPUS, and socINDEX) in English or French peer-reviewed journals (search strategy in Supplementary File S1). We also examined grey literature (non-peer-reviewed literature, e.g. research reports, training manuals, communication tools) by soliciting, via email, a network of 31 Canadian academic and non-academic researchers. The network included co-researchers and collaborators in the broad research initiative that funds our study as well as participants in a scientific seminar we organized with academics and practitioners. We also performed backward citation tracking to identify additional references. The original search returned 513 references, among which 108 were from the grey literature (see PRISMA flowchart, Fig. 1) (Tricco et al., 2018).

Fig. 1
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PRISMA-ScR flow diagram (Tricco et al., 2018)

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Screening and selection

To capture nuances of expression across public health domains, researchers from different public health backgrounds (public health, environmental health, occupational health, community health) and disciplines (ergonomics, psychology, sociology, economics, management) were involved in screening decisions. Inclusion and exclusion criteria were applied to both the grey and peer-reviewed references (Table 1).

Table 1 Inclusion and exclusion criteria
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Two researchers independently screened peer-reviewed and grey literature based on title and abstract, and then on full-text (see Fig. 1). All disagreements were resolved through consensus with a third researcher.

Among the 125 full-text documents assessed for eligibility, 106 were excluded due to a lack of generalizable guidelines analyzing PR in relation to S/G; or focused on a single gender (usually women) without examining issues such as power imbalances, inequities, or injustice. Nineteen documents met the selection criteria and were included in our review (PRISMA flowchart, Fig. 1) (Tricco et al., 2018).

Data extraction

A first data extraction tool was developed comprising five dimensions: document characteristics, intervention characteristics, attributes of actors, underlying conceptualization of key concepts, and recommendations related to partnership and S/G (Table 2).

Table 2 Dimensions of the data extraction tool
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Data were independently extracted from the 19 documents by two researchers and validated by a third researcher. During the extraction process, two sections were added to our extraction tool: one included a scale of gender integration (CIHR, 2016c) and the other characterized the recommendations as being either concrete or general.

Two subthemes also emerged. “Intersectionality” was attributed to documents that framed S/G in combination with other types of oppression based on class or racialization (Collins, 2019; Crenshaw, 1989). “Reflexive practices” took into account a specific type of recommendation that could include (1) awareness of one’s own positionality in relation to others (power imbalances), (2) examination of the prominence of certain voices over others in a project and subsequent outcomes on actors, partners, and community, and (3) reflection on the research project itself and how decisions are made (see 19 extraction grids in Supplementary File S2) (Blanchet, 2009; Huang et al., 2018).

Mixed-method synthesis: qualitative coding and cluster analysis

We used type-building as a text analysis method to classify our complex and multidimensional data into patterns (Kuckartz & McWhertor, 2014). We conducted a mixed-method synthesis with a sequential design: step (1) qualitative analysis of the data in the 19 extraction grids; step (2) quantitative cluster analysis based on the qualitative coding to help us organize and classify the information collected on each document.

Qualitative coding of recommendations

Researchers agreed on the categories of extracted data that were most critical to typology development and that showed potential for characterizing types (Kluge, 2000; Kuckartz & McWhertor, 2014). The first step of this process was to interpret all extracted data related to recommendations (“how-tos”). We used directed qualitative content analysis following a deductive/inductive approach, to identify, in the corpus, any data related to predefined coding categories presented in Table 3 while allowing new categories to emerge (Assarroudi et al., 2018).

Table 3 Synthesis coding categories for recommendations
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All data in the recommendations dimension of our extraction grids were coded using the following codes: (1) PR codes which were based on (a) seven temporal components ranging from building the partnership to dissemination and large-scale application, and (b) transversal aspects such as overall context (e.g. history of the partnership), partnership processes that span the duration of the project (e.g. how decisions are made), and macro-level processes of knowledge construction (CIHR, 2016a; Lebel, 2003; St-Vincent et al., 2014; Wallerstein & Duran, 2010); and (2) S/G codes, namely (a) root causes of inequities, e.g. underlying mechanisms, (b) gender-based approaches applied to PR processes, and (c) sociopolitical transformations (CIHR, 2016c; Hankivsky, 2005). Reflexive practices and intersectionality codes were assigned when these concepts were operationalized in recommendations (more details provided in Table 3) (Blanchet, 2009; Collins, 2019; Huang et al., 2018). Recommendations were coded independently by two researchers and differences were resolved by reaching consensus.

To illustrate how documents contributed to our research objective, we created a two-dimensional matrix with the S/G codes in rows and the PR codes in columns and displayed the 19 documents at intersections (Table 4). Each document could be displayed in several cells (or intersections) of the table, depending on the coding of the various recommendations extracted from the document. Recommendations that did not concern S/G or PR were eliminated as being outside of our scoping review objectives.

Table 4 Sex/gender and participatory process synthesis matrix
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Cluster analysis

An unsupervised (without predefined classes) clustering approach in the form of a partitional clustering was then performed to provide a multivariate classification grouping the 19 documents into clusters. This method is widely used with nominal (categorical) variables (Macia, 2015; Saxena et al., 2017) and also common when building types with heterogenous attributes (Kuckartz & McWhertor, 2014).

All variables related to the characteristics of recommendations (S/G; PR; reflexive practice; intersectionality) were included in the cluster analysis so as to favour the emergence of types (Kluge, 2000). In addition to the recommendation-related codes, the cluster analysis took into account two other characteristics of the documents included in the extraction grids: four degrees of gender integration, from gender awareness to gender transformation (CIHR, 2016c); and the presence of concrete recommendations, namely action checklists, procedures, steps (non-concrete recommendations, which were not included in the cluster analysis, offered advice in the form of general principles or prescriptions).

Using nVivo12 software, the Jaccard coefficient was applied because it is well adapted to binary data (Macia, 2015; Saxena et al., 2017) to measure the level of similarity between each pair of documents. Documents were grouped using the complete linkage (farthest neighbour) algorithm. The number of clusters to be analyzed was based on dendrogram graphic analysis (Supplementary File S3) and the interpretability of clusters as providing “meaningful classes” (Saxena et al., 2017).

Results

Document characteristics

Out of the 19 documents included in this scoping review, five were from the targeted subfields (OH=3; EH=2) and the remaining 14 covered various other public health domains (such as population and reproductive health, community health, minority health and health disparities, and women’s health) (see detailed characteristics of 19 documents in Supplementary File S2).

Most of the documents were peer-reviewed articles (15 of 19). Their publication dates revealed stability of the topic over time: four to six documents were published within each 5-year period between 2000 and 2020; therefore, resources supplying ways on how to take account of S/G in PR have not increased despite repeated calls in the literature (Manandhar et al., 2018; Tannenbaum et al., 2016). Eight of the documents originated from Canada, five from the United States, and one from each of the following countries: Australia, Denmark, France, South Africa, the United Kingdom, and Zimbabwe.

Documents varied in the nature and amplitude of their contribution to the different intersecting PR and S/G subcategories of the coding matrix (Table 4). In particular, the coding density showed that the three categories of S/G integration (represented by the rows in Table 4) were not equally populated with recommendations from documents considered in our review. Where the documents resulting from our literature search provided guidance was especially in procedural aspects of implementing S/G-sensitive research and partnership processes. Our scoping review revealed a dearth of recommendations in identifying the root causes of S/G inequities (e.g. gender norms, roles, and relationships and their potential impact on access/control over resources). These were less frequently discussed in recommendations, except when the recommendations concerned data collection or analysis. In a reflexive exercise based on the guidelines identified in our scoping review and conducted in the context of our parallel participatory process, research partners reinforced the need for further guidelines to face related challenges.

We also noted that the three OH documents were comparatively silent in relation to many of the subcategories related to S/G sociopolitical transformations—which involved explicitly augmenting participants’ agency and influencing policy design. Dissemination and large-scale application (PR subcategory) was an exception as it included, for instance, recommendations from Chappert et al. (2014) describing the impact of their research in inspiring changes in law so as to favour S/G equity in OH.

Typology: four clusters

The synthesis phase resulted in four clusters grouping documents by type (Fig. 2).

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Typology of documents

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Type 1 includes three documents that focused strongly on participants’ empowerment through the PR process. Type 2 comprised five documents offering the most concrete recommendations with ready-to-use guidelines for researchers about to engage in S/G transformative PR. The documents in Type 3 addressed PH issues experienced by vulnerabilized or marginalized populations, putting forth intersectional approaches and a specific stance on reflexivity to reinforce links to large-scale spheres of actions. Documents in Type 4 described interventions that would have direct impacts on the health of the target population.

More details on the complete typology are found in Table 5 which refers to the variables used to constitute the clusters, complemented by characteristics of the documents and paraphrased excerpts (italic) from the recommendations identified during data extraction (see Supplementary File S2 for the complete data extraction grids).

Table 5 Typology of documents
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Discussion

Our typology highlights two main loci where S/G transformational change arises in PR. While both can coexist in projects, the documents tend to emphasize one over the other. First, there are projects in which health and S/G inequity transformations are achieved with individuals and local scale groups throughout the implementation of the project (Type 1). Second, participatory projects can also serve to develop recommendations, policies, and tools that could ultimately lead to social change, thus reducing S/G inequities (Types 2, 3, and 4).

The documents clustered around other characteristics as well. Type 2 offers the most ready-to-use guidelines for researchers about to engage in PR integrating S/G. Type 3 provides recommendations for working with a diverse partnership composition (e.g. community and governmental agencies) to ensure micro- and macro-level actions on S/G. Finally, Type 4 delves into strategies at the stakeholder level for navigating S/G-related obstacles when directly targeting health outcomes. Researchers looking to integrate S/G into the specific steps of PR methodology (e.g. research framework development or data collection and analysis) can turn to most of the 19 documents in this review for recommendations. However, several blind spots were identified, indicating a need to generate guidelines and recommendations to complement those found in this review.

Gaps in knowledge

In line with our findings, we must first acknowledge the influence of our own positionalities as S/G scholars and practitioners on the identification of these gaps. Despite various career paths, socio/linguistic backgrounds, experience levels, and academic statuses, all authors have gravitated toward research networks where S/G integration is a central preoccupation. This common interest provides fertile ground for us to explore these issues together in a non-confrontational context, without negative personal or professional consequence that can sometimes occur in academic and practice settings. Also, as OH and EH scholars, we delimitated our analysis to these widely interdisciplinary PH domains and, thus, oriented our reflections accordingly.

Availability of guidelines for researchers with differing levels of S/G or PR experience

The first gap is related to the usability of advice provided in the documents. We observed that Type 2’s very concrete guidelines imply a readiness to integrate S/G in PR. As a matter of fact, this presupposes sufficient preliminary skills and knowledge about partnership processes, on the one hand, and S/G issues, on the other. For example, a document such as the Native Women’s Association of Canada (2010) workbook, which offers applied and concrete steps, assumes a certain level of understanding of S/G with regard to participatory approaches. Further thought needs to go into the factors enabling the progression of knowledge and experience acquisition to tailor future tools to the needs of knowledge users from diverse disciplines and with varying levels of experience.

Guidelines covering all levels of S/G integration

Our review reveals a second gap, namely that not all of the S/G categories were equally provisioned with recommendations (Table 4). While the second category, that of research design, was largely covered by many documents, there is a need for more guidelines related to Identifying root causes of S/G inequities and S/G sociopolitical transformations. Identifying root causes of S/G inequities, the least supplied S/G category, could be reflected upon in more phases and transversal components of PR to avoid reproducing inequities within the partnership process itself and to ensure that knowledge translation addresses issues inclusively. S/G sociopolitical transformations, recommendations for which were found in relatively few guidelines except at the intersection of Dissemination and large-scale application, requires moving away from end-of-grant knowledge translation as a dominant model. The relative scarcity of recommendations for this in other phases of PR reveals a need to help researchers in co-creating, with collaborators, enabling conditions for partners to carry out interventions that lead to S/G sociopolitical transformations from the partnership building phase until after project funding has ended. This could be a solution to challenges posed by grant timelines that, once finished, preclude fieldwork in which valuable knowledge necessary for effecting sustainable change could be mobilized. Such guidelines would offer tools to ensure that PR results have lasting impacts and do not inadvertently lead to negative consequences.

OH/EH specificity

In line with our objective to identify gaps in knowledge with a focus on EH and OH as subfields of public health, we observe that the OH documents (all in Type 4) are more distant from other public health subfields than EH documents appear to be. We interpret these differences in light of specific challenges involved in conducting PR in OH, namely that improving workers’ health often depends on the willingness of an employer to grant access to its workplace. Participatory research in other public health subfields is more often requested by and for communities to which access may be difficult but is not mediated by a contractual relationship (e.g. employer-employee, union-management). OH researchers’ power over the research process and its transformative outcomes on S/G issues can be fragile and may have influenced the type of guidelines that were provided. Indeed, one of the recommendations stemming from OH research was to adopt an implicit approach where the intention to tackle S/G issues was not revealed at the beginning of the process in order to maintain partnerships. In this strategy, S/G is brought up late in the process, when presenting relevant research results, and suggestions for organizational transformations remain universal (i.e. concern all workers). This approach was not promoted by other subfields of public health, including EH, but was observed in a retrospective study of OH interventions by Laberge et al. (2020). Considerations of power issues within the partnership itself, especially those arising from social and gendered relations, were addressed in reflexive practice guidelines and are especially present in Types 1, 2, and 3, but rather absent from Type 4. This highlights the necessity to support OH researchers with additional guidance on how to prevent inequities within the PR process. OH research can nevertheless look to other public health subfields for recommendations—especially those related to intersectionality and reflexive practices. As for EH, the relatively small number of documents (2) points to a need for more guidelines on S/G and PR in this domain.

The role of intersectionality and reflexive practices in recommendations

Many of the documents in this review point to the complexity of engaging in a genuine S/G transformative process. Recommendations concerning intersectionality and reflexive practices are aimed at helping researchers and practitioners navigate this complexity. Increasingly, scholars are recommending that researchers state and analyze their own positions and adopt an intersectional approach that encompasses S/G, among other forms of marginalization (Hankivsky et al., 2018; Messing et al., 2022; Muhammad et al., 2015). All clusters but Type 4 give guidelines and recommendations on implementing a reflexive and intersectional approach. Most PR in our scoping review worked with populations in varied and often cumulative situations of vulnerability and marginalization. In some of these documents, S/G issues were not considered to any greater extent than other forms of inequities, which at times had the effect of obscuring S/G. For instance, the fact that S/G is sometimes mentioned at the beginning of a document without any further mention may give the impression that “how-tos,” taken out of context, are not S/G-related when, in fact, they are simply not focused on S/G more than any other form of injustice. Challenges related to the operationalization of intersectionality in PR have been identified as an obstacle to taking account of S/G (Manandhar et al., 2018; Tannenbaum et al., 2016). Our review supports the idea that “methods to integrate intersectionality into research and policy are still at an early development stage” (Gogovor et al., 2020, p. 8). Concrete guidelines are needed regarding analytical methods to capture cumulative oppressions without masking or losing sight of S/G issues.

As for reflexive practices, strong cases for their integration were made in three of the four clusters (Types 1, 2, and 3). A central aspect of reflexivity touches on S/G power relations among academic researchers, stakeholders, partners, and participants, each implying distinct dynamics. When working directly with communities, conventional power relations most often favour the researcher and, as proposed by Muhammad et al. (2015), it can be helpful to exchange explicitly about power relations during a project. In other words, it is within the “power” of academic researchers to contribute to rebalancing power relations, an effort that may involve considering the interaction between the academic researchers’ own position (e.g. sex/gender, age, ethnicity, socioeconomic status) and that of partners, stakeholders, and participants. As for OH, the fact that none of the documents involved an explicit reflexive process raised a question among the advisory committee about whether that possibility is not always within reach, especially when researchers are bound by partners’ willingness to allow access to workplaces and workers. While eliminating S/G power structures entirely might not be realistic for all contexts, in EH as well as OH, a reflexive process can still have benefits in attenuating some detrimental S/G power differentials. To that end, many guidelines in the documents most concerned with intersectional analysis provided precise ways to reflect on unconscious biases in the partnership process (Agénor, 2020; Muhammad et al., 2015). Muhammad et al. (2015) describe instances where stories are shared in confidence with researchers who are trusted as “one of the community” and that cannot later be used as data as they are deemed too sensitive. In light of these considerations, both general and practical guidelines are needed to develop reflexive strategies for each participatory project, according to its context.

Finally, several strong articles were excluded for this scoping review because they did not provide recommendations specifically addressing S/G power relations or inequities. This can occur in articles that take an intersectional perspective, as authors provide best practices for dealing with power differentials in general but do not necessarily refer to S/G specifically. Some of these articles could nevertheless serve as examples of useful guidelines (for example, in EH: Canfield et al. (2016); Downs et al. (2011); in OH: Di Ruggiero and Sharman (2011); Men’s health: Schoenfeld and Francis (2016); other PH domains: Andrews et al. (2012); Carrière (2008); Chang et al. (2016); Gregg et al. (2010); Mendes et al. (2016); Robertson-James et al. (2017); Samaras et al. (2014); Shea et al. (2013); Wuest et al. (2015)).

Strengths and limitations

This scoping review has several strengths. First, it is rare that public health subfields as traditionally siloed as OH and EH are both analyzed around S/G integration- and PR-related concepts. This fostered an original and fine-grained analysis through a continued dialogue at all phases of the scoping review, and especially when double-coding extracted data. Also, our scoping review followed a rigorous methodological process, i.e. systematic search of nine databases, coverage of the grey literature, and interjudge procedures. A mixed-methods approach, with participatory, qualitative analysis followed by a cluster analysis, allowed for a detailed and in-depth synthesis process.

The review also has limitations. First, the predominance of peer-reviewed articles in our sample may result from one of our inclusion criteria (recommendations had to be intended for people conducting research) and the fact that the grey literature is not indexed, complicating exhaustive searching. This may have influenced the nature of extracted recommendations. While toolboxes and training manuals are expected to share steps, activities, and best practices, authors of peer-reviewed articles, by academic tradition, may avoid endorsing their detailed and concrete methodologies, rather, making broad recommendations/reflections to be integrated by others in their own practice. For example, selection criteria for partners (education level, community or target population membership, availability) were often pointed to as important in the methodology, but were not systematically formulated as recommendations, Chigudu (2007) being an exception.

Second, the cluster analysis corresponds to an exploratory approach. Although it was based on a limited number (19) of documents, this quantitative method supported the analysis of a large number of attributes to build types (Kuckartz & McWhertor, 2014). Empirical and theoretical interpretation reinforce the validity of the dendrogram analysis and the distinct clusters that emerged from this analysis.

Finally, our “shared understandings” as a team may sometimes have differed from those of the authors of the documents that we analyzed. We tried to reduce the influence of our own positionalities on the results to a minimum through reflexive practices, such as addressing potential biases during our advisory committee meetings, and by mobilizing inclusive and transdisciplinary conceptualizations of our scoping dimensions. Given the relatively low socio-demographic diversity, including in terms of S/G, within the advisory committee, our analysis may be lacking in some dimensions.

Conclusion

Our review illustrates that the obstacles to integrating sex and gender in participatory research are not only related to the complexity of planning or implementing such projects (Gogovor et al., 2020) but also to the scarcity of guidelines. Guidelines related to epistemic justice and enmeshed in feminist ethics frameworks would ensure that researchers’, participants’, and stakeholders’ standpoints are taken into account both in the participatory and the research processes, and could clarify how these two processes can support the reduction of health inequities, without masking S/G issues in relation with other types of vulnerabilities or marginalization (Fricker, 2007; Messing, 2021).