Consideration of sex/gender in publications of quantitative health-related research: Development and application of an assessment matrix

**Background:** Despite growing recognition that sex and gender must be integrated into health research, existing evaluation tools apply selective criteria and lack standardized visualization. The authors aimed to develop a comprehensive, theory-based matrix to assess and visualize sex/gender consideration across the full research process in quantitative health studies.

**Methods:** The matrix was developed iteratively within the INGER (Integrating Gender into Environmental Health Research) project, drawing on the INGER multidimensional sex/gender concept and three published guidelines: STROBE, SAGER, and PRISMA-E 2012. The matrix was structured into sections (title/abstract, introduction, methods, results, discussion) with 14 criteria, each having 2–4 rating levels (a = not at all, through d = highest). Two independent authors tested the matrix on two sets of publications: 7 studies from Bolte et al. (sex/gender in green space and self-rated health) and 11 studies from Rompel et al. (sex/gender in noise and hypertension/ischemic heart disease). Visualization was done in R using the flextable package.

**Key Results:** The final matrix comprises 14 items: (1) precise use of sex/gender terminology; (2) sex/gender in title; (3) sex/gender in abstract; (4) rationale for sex/gender consideration; (5) sex/gender in objectives; (6) hypotheses; (7) source of recruitment information; (8) selection of study population; (9) data collection and operationalization; (10) sex/gender variety and multidimensionality; (11) sex/gender-specific analysis; (12) description of study population; (13) sex/gender-specific results; (14) discussion of sex/gender results. In both exemplary applications, none of the 18 publications achieved a rating better than 'a: not at all' for criteria 1 (precise terminology), 2 (title), 6 (hypotheses), or 10 (variety/multidimensionality). Publications from Bolte et al. (which required sex/gender keywords in title/abstract) showed better ratings overall, particularly for abstract-related criteria, compared to those from Rompel et al. (which only required sex/gender-specific effect estimates).

**Clinical Implications:** The matrix provides a standardized tool for researchers, reviewers, and decision-makers to evaluate how well sex and gender are integrated into quantitative health studies. By identifying specific weaknesses—such as the universal failure to consider sex/gender beyond a binary or to formulate sex/gender hypotheses—the matrix highlights where methodological and reporting improvements are urgently needed. The authors recommend the matrix be adapted for specific research fields and supplemented with deeper qualitative analysis when needed. The tool is intended to support more sex/gender-equitable health research by making gaps visible and comparable across studies and disciplines.