Effects of the Social Determinants of Health on Gendered Experiences of the ‘Sick Role’: A Cross-sectional Study in Khulna District

Introduction: The United Nations Sustainable Development Goal (SDG) 3 focuses on equal

health and well-being for all. However, based on the Social Determinants of Health (SDoH), a

gendered difference in sick role experiences is observed in Bangladeshi families, including

exemption from daily household chores during illness. Despite Parsons' idea of the sick role

emphasizing expected behaviors during illness, little study has looked at how SDoH affects

this experience between men and women in Bangladesh. Therefore, this study aims to

investigate the prevalence and determinants of sick role rights and obligations for men and

women within the family context.

Methods: This study followed an explanatory approach, with a survey research design. A

multistage random sampling technique was applied to select 400 respondents to take part in

this study. An interview schedule was developed to collect survey data, which took place with

the respondents between March and April, 2025. Afterward, descriptive and inferential statistics were used to analyze data.

Results: The results showed the prevalence of sick role rights and obligations for both

genders. Gender variations were observed in the context of sick role rights, with 31.5% of

men reporting access to sick role rights compared to 23% of women. Similarly, in terms of

sick role obligations, 39.5% of men reported fulfilling their obligations compared to, 42% of

women. The study reveals that SDoH significantly influence the sick role experiences of both

men and women within families. Among men, several factors, such as education,

employment, income, expenditure, food security, social support showed significant

associations with increased likelihood of both sick role rights and obligations. For example,

having secondary education of men was associated with increased likelihood of both sick role

rights (AOR = 2.06, 95% CI: 1.31–2.93, p < 0.001) and obligations (AOR = 1.62, 95% CI:

1.15–2.08, p < 0.001). For women, several factors, such as education, employment, income,

expenditure, residence pattern, distance to the facility, social support, religion and age were

found to be determinants with increased likelihood of both sick role rights and obligations.

For example, semi-urban residence was linked to both sick role rights (AOR = 1.42, 95% CI:

1.04–2.61, p < 0.001) and obligations (AOR = 2.00, 95% CI: 1.39–2.88, p < 0.001) among

women.

Conclusion: Gender variations in sick role rights and obligations are evident. A

higher number of SDoH were related to sick role rights and obligations for women

compared to men. To increase equal sick role rights and obligations, findings from the study

recommend reducing familial pressure, improving health literacy, and ensuring gender-

sensitive, accessible, and affordable healthcare.

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