HIM Best Practices for Engaging Consumers in Their Overall.docx

HIM Best Practices for Engaging Consumers in
Their Overall Healthcare
As a nation, the United States has been focused heavily on
engaging consumers in their overall health and wellness.
This has been propelled by federal initiatives such as the
“meaningful use” Electronic Health Record (EHR) Incentive
Program, mandated clinical quality measures based on the value
of care provided, and programs such as the Centers
for Medicare and Medicaid Services’ (CMS’) Hospital Compare,
which now includes star ratings on patients’
experience of care.1, 2, 3
Stage 2 of meaningful use includes the objective to “provide
patients the ability to view online, download and
transmit their health information within four business days of
the information being available to the eligible provider
(EP).”4 This is measured by patients’ or authorized
representatives’ online access to their health information.
Federally mandated clinical quality measures and the measures
included in the meaningful use program suggest that
patients receive better outcomes and care coordination and
management when they are engaged in their healthcare.5
Patients’ and caregivers’ ability to access their health
information electronically helps to facilitate this engagement.
Technology has propelled consumer engagement by making
patient records easily accessible to consumers through
patient portals. Advanced technology has also allowed for

information to be shared more easily between care
providers. Technology is enabling patients to “consult with
physicians, receive diagnoses and even get prescriptions
via videoconference. Additionally, mobile health tools,
including wearable sensors and phone applications that qualify
as medical devices, allow better monitoring of patient
conditions.”6 Though interoperability between EHR systems
exists as a barrier, health information management (HIM)
professionals are able to mitigate this hurdle by serving as
stewards of patient records and assisting physicians in patient
advocacy.
This Practice Brief discusses the challenges of engaging
healthcare consumers and offers best practices for HIM
professionals to assist consumers in becoming more engaged in
their own healthcare. It is designed to support and
guide healthcare organizations, HIM professionals, and
healthcare providers on how to assist consumers in
improving communication as well as providing insight into how
technology is shaping the role consumers play in
healthcare.
Outlining the Role of HIM in Consumer Education and
Advocacy
Due to increased regulatory demands on healthcare providers,
HIM professionals are in a unique position to facilitate
consumer engagement from admission to discharge in any type
of healthcare setting. There are numerous tools
available that assist in educating the consumer regarding their
health information, including:
� Consumer Health Information Bill of Rights: This resource is
available online via AHIMA’s HIM Body of
Knowledge to educate consumers on the protections and
safeguards related to their personal health

information (PHI).
� AHIMA’s Engage Consumer Engagement and Personal Health
Information Community: This online
community, at engage.ahima.org, is accessible to the public to
discuss issues related to consumer access to
Copyright © 2015 by The American Health Information
Management Association. All Rights Reserved.
http://www.ahima.org/copyright
their health information, including personal health records
(PHRs), PHI, patient portals, personal health
monitoring technologies, care coordination, and case
management.
� MyPHR: The MyPHR.com website offers a wealth of
information for consumers, caregivers, and healthcare
professionals including information on how to start a PHR,
health literacy tools, and tips to navigate the
healthcare system. This site can be used to educate HIM staff,
consumers, and caregivers.
� Blue Button: This initiative offers consumers a way to get
their health records electronically. Regardless of the
type of healthcare setting, HIM professionals should discuss
taking the Blue Button pledge with their
organization to empower consumers to be partners in their
healthcare through health IT. Consumers will be
able to access their health data, improve their health and
healthcare experience, and understand ways to
safeguard and protect their health information. More
information on Blue Button is available at
http://healthit.gov/patients-families/your-health-data.

� ShareCare: The ShareCare.com website is an online health
profile and community where consumers can find
experts to answer health questions, find doctors, and learn from
the top experts in health and medicine.
AHIMA is partnering with ShareCare to offer resources and
answers on consumers’ right to access and
protect their health information. More information is available
at www.sharecare.com/group/ahima.
� Medical Identity Theft Response Checklist for Consumers:
Consumer awareness is vital for detection of and
timely response to a medical identity theft incident. Consumers
may consult this checklist, available online in
AHIMA’s HIM Body of Knowledge, for practical guidance and
rapid action.
Another way to facilitate consumer engagement is to become
involved in facility-based committees that address the
multiple areas that intersect with consumer access, amendments,
and sharing of personal health information. This
could include an organization’s policy, procedure, and contract
committees that ensure consumers are able to access
their information within a reasonable timeframe and that
assistance can be provided if necessary. If this type of
service is outsourced to an EHR or patient portal company, HIM
professionals should make sure the contracts
specify that consumers have access to their health information
and provides education on the importance of having
access.
HIM professionals should be involved in developing the patient
portal functionalities, assisting in creating a program
at their facility that provides tangible information on the
importance of patients having secure access to their

information, as well as supporting consumers through the portal
sign-up process.7,8,9 Because patients are becoming
more involved in their own healthcare, HIM professionals will
need to collaborate with the medical, nursing, and
other clinical staff who have direct contact with the patient in
ensuring they are receiving copies of their discharge and
aftercare instructions and that their laboratory test results are
available in the patient portal where applicable. HIM
professionals also need to consider allowing patients to review
their medical record while they are still at inpatient
status or still on campus, such as patients in outpatient surgery
recovery or those being held at the hospital for
observation.10
Outlining the Role of HIM in Assisting Physicians with Patient
Advocacy
The role of the HIM professional as steward of the patient
record is vital in assisting the physician in patient
advocacy. The HIM professional should be part of a team of
care professionals at the organization that promotes a
culture of valuable service to the patient. As a third party, the
HIM professional is the keeper of the record and is
well positioned to assist the physician with his consumer—the
patient.
Promoting HIM Services
The HIM professional can serve the patient through the
physician by promoting the best quality standards in
information governance (IG). An example would be to produce
data analytics for patient populations to establish

new patient services and to support business decisions made
based on the information captured. HIM professionals
have their eyes on the details to ensure data integrity and
completeness.
HIM professionals should:
� Be open to patient interaction through health information,
patient research, auditing, input, and collaboration.
� Assist in the avoidance of duplicate tests; audit and improve
quality care by auditing records for quality
discrepancies.
� Ensure timely and accessible information so that the best
medical decisions can be made by care providers.
� Establish practices that are designed with the patient
perspective in mind.
Employing a Consumer Engagement Campaign
The HIM professional can serve as a resource for the physician
by way of consumer assistance. To introduce this
concept, a consumer assistance campaign could be developed
and marketed to physicians and staff. This campaign
should acknowledge consumers and the need to empower
patients to become collaborators in their care and medical
decision making. It is essential that an explanation of services
offered is included, and that the use of health
information as a communication tool is promoted. The HIM
professional should promote complete and timely
documentation, ensure proper documentation and coding for
reimbursement, and ensure proper billing of services.

The HIM department should create a culture of trusting
engagement by providing a secure environment that allows
the patient to feel comfortable when accessing and requesting
their patient information. Staff should be trained to
understand consumers and their needs. Resources should be
allocated so that time is devoted to the needs of the
patient. HIPAA rights should be clearly stated in the view of the
patient. Publishing a standard fee for photocopies
(whatever is established for your state) and providing a courtesy
copy for first requests would be beneficial for all
involved. Establish a team of experts in coding, release of
information, and problem resolution to assist the patient
with questions regarding their care and bill denials and appeals.
Information Governance Supports Health Record Stewardship
The presence of a strong information governance (IG) program
in a facility supports the ability of HIM
professionals to serve as stewards of patient records, as well as
assist in patient advocacy roles, as
illustrated through two of the Information Governance
Principles for Healthcare (IGPHC)™—
Transparency and Availability. The IGPHC are industry-specific
IG principles adapted from ARMA
International’s Generally Accepted Recordkeeping Principles.
Principle of Transparency
An organization’s processes and activities relating to
information governance should be documented in
an open and verifiable manner. Documentation shall be
available to the organization’s workforce and
other appropriate interested parties within any legal or
regulatory limitations and consistent with the
organization’s business needs.

Principle of Availability
An organization shall maintain information in a manner that
ensures timely, accurate, and efficient
retrieval.
Opening the door to a culture of patient advocacy and building a
team that is recognized for patient engagement is
essential. HIM professionals have many responsibilities to fill
in making this a reality, from accurately abstracting the
medication list, problem list, allergies, and other health
maintenance areas to providing an avenue for patients to
make amendments to his or her health information. HIM
professionals also have a role in pushing portal messages
out to patients.
Establishing an HIM-Physician Relationship
The HIM professional and the physician should be working in a
collaborative manner to serve the patient. This
working relationship begins by establishing a customer-friendly
relationship between HIM and the physician and their
staff. Allow the physician to use HIM as a valuable resource to
attain a high level of patient satisfaction. Develop a
positive direct relationship with the office staff by hosting an
open house or ask to speak during their lunch. Contact
the physician if there are legal actions or concerns. Assist in
keeping patients out of the hospital by performing audits
with established measurable criteria around patient conditions,
medication, and test results. Promote patient choice

on medical decisions by providing a copy of the clinical
summary with physician comments to the patient. Ensure that
the physician links the patient’s understanding of medication
interactions for improved compliance. Participate in
compliance of prescribed medication by auditing and informing
the physician of discrepancies. The HIM professional
can provide valuable information to the physician and staff via
outcome studies and results.
Areas of training that HIM staff could provide include:
� Training front office staff or physicians on how to use the
patient portal
� Training front office staff on how to respond to denials and
payments
� Providing training on patient rights under HIPAA
� Explaining caregiver benefits
� Giving tips on navigating through the HIM world
� Helping physicians understand the importance of consumer
engagement and providing education to physicians
on engaging consumers
� Educating on the importance of quality and legal
documentation
� Explaining the importance of data sharing
� Communicating with physicians about telephone visits—
encourage physicians to be willing to accept those
appointments and how to properly document and receive
reimbursement; create policies that address written
documentation of these phone calls, including policies that
allow a patient to get a copy of a phone note
� Offering patient training on patient rights
� Developing a train-the-trainer curriculum for patient care
staff or a simple fact sheet for consumers

� Providing a tutorial to staff on the components needed to
complete a patient authorization for release of
information
HIM Code of Ethics Applies to Consumer Engagement
The AHIMA Code of Ethics provides HIM professionals with
ethical principles to guide professional
conduct based on the core values of the organization. These
principles include facilitating
interdisciplinary collaboration in situations supporting health
information practices and respecting the
inherent dignity and worth of every person. When in a
professional setting, HIM professionals should
provide only facts and refrain from including personal opinions.
And in all interactions, it is important to
be kind and professional. Through their skills, knowledge, and
patient advocacy support, HIM
professionals can add great value to the physician-patient
relationship.
Outlining the Role of HIM in Consumer Engagement
Organization-Wide
HIM professionals play an important role in making sure the
correct information is included in inpatient discharge
papers—or in the “after visit summary” document that is
provided at the end of an outpatient appointment. Discharge
notices should also correctly indicate the type of provider

facility, such as a long-term care or inpatient services
provider.
Getting advance notice of an upcoming discharge from a
hospital or long-term care setting is vital to advocating on
behalf of patients who are planning to be discharged, especially
if the patients or their caregivers feel that the
discharge is not appropriate. Good discharge planning on the
part of patients, their caregivers, and their providers is
essential for a successful transition from one care setting to
another.
Notice can be given through a written or verbal discussion of
the patient’s rights, especially with respect to
anticipated out-of-pocket costs, the types of treatment that may
be needed, and when identifying the setting in which
care will be received (i.e., inpatient, outpatient, or long-term
care). It is important that this type of notification is
provided as far in advance of discharge as reasonable. The
discharge notice should be provided in writing, even if
first given verbally. It should be given in a way that is
understood by the patient and it should be available in multiple
languages. Notice can be provided to the patient or it can be
provided to a caregiver who, with patient permission,
can explain the discharge information to the patient.
HIM professionals should be involved in assisting with
developing the appropriate language for the written discharge
notice. The discharge notice should include:
� Expected date of discharge
� Any information that is needed for patients who wish to
object to a planned discharge, such as where to file an
objection, what agency or who will review the objection, and
the address and telephone number of the

appropriate person to contact
The written discharge plan should explain at a minimum the
following information in easy-to-read verbiage:
� Where the patient can get additional healthcare after
discharge
� What the patient and caregivers can do to help provide for the
patient’s ongoing healthcare needs
� Steps to take for any questions that arise, or help in
identifying any complications or problems that should be
reported to their healthcare provider
� A list of medications with instructions for taking them
correctly
� Instructions on how to make arrangements for home health
equipment or other medical supplies if necessary
� Information about where and when follow up should occur
A discharge plan does not have to follow an exact format, but it
should be understandable and brief. It should be
shared with the patient and any caregivers that the patient
designates. The discharge plan should be included as a
part of the patient’s medical record.
Educating Staff on EMTALA
The Emergency Medical Treatment and Active Labor Act
(EMTALA) was passed in 1986 as part of the
Consolidated Omnibus Budget Reconciliation Act (COBRA).11
It requires hospitals that accept Medicare payments
to provide emergency treatment to anyone needing it regardless
of their ability to pay. Any hospital that accepts
Medicare may not transfer or discharge any patients that request
emergency treatment, except with patient consent,

or after providing a medical screening exam to evaluate the
need for emergency care, or when the patient’s medical
condition requires transfer to a different hospital that is better
prepared to provide appropriate treatment.
The essence of the EMTALA law states that if patients say it’s
an emergency, then it is considered an emergency
and should be treated as an emergency. HIM professionals
should educate all staff in the organization to tell patients
to come in and be seen if they feel they are having a medical
emergency. It is critical that all registrars and all nursing
or patient care staff are aware of the rules of EMTALA. The
desired outcome is for the general public to also know
that they have a right to determine whether or not they have a
medical emergency that requires emergency treatment.
Hospitals have three requirements under EMTALA:
1. Patients who request emergency treatment (or the patient’s
representative who makes the request if the
patient is unable to do so), must be provided with a screening
exam to decide whether or not a medical
emergency exists. The hospital cannot wait to provide the exam
and any needed treatment to ask about
payment or to get information about insurance coverage. The
hospital may begin the process of asking
payment questions or inquiring about insurance coverage once
the patient has been screened to ensure that
obtaining the payment information will not interfere with the

patient’s care.
2. The emergency room (or another unit within the hospital if it
is better equipped to handle the patient) must
treat a patient with an emergent condition until the condition is
stable or resolved, and the patient has the
ability to provide their own care after discharge, or until they
can receive after-care. If the hospital provides
inpatient care, it must be provided at an equal level for all
patients, regardless of their ability to pay. Hospitals
may not discharge a patient prior to making sure they are stable,
even if the patient’s insurance is canceled or
if the patient otherwise stops being able to pay during the
course of the inpatient stay.
3. If the hospital does not have the ability to treat the patient’s
condition, the hospital must make an appropriate
transfer to another hospital which has the ability to treat the
patient’s condition. This includes a long-term or
rehab facility for patients who are unable to care for themselves
at home. Hospitals that have specialized
capability must accept the patient in transfer and cannot
discharge the patient until the condition is resolved
and the patient is able to provide care for themselves, or until
such time that they are transferred to a different
facility.
The Role of HIM Before, After, and Between Patient Visits
E-mail is now a part of our everyday lives. We use e-mail at
work to communicate with coworkers. We use e-mail
at home to keep in touch with friends and family. Today, many
healthcare professionals are also communicating with
patients through e-mail.
Provider-patient communications were traditionally done

through in-person meetings, such as during an office visit or
on the telephone, or by providing written information. Home
computer technology adds another convenient form of
communication—the ability to communicate through e-mail or
the Internet with a patient portal. There are a number
of advantages to using e-mail or a patient portal to communicate
with patients:
� E-mail or portals allow for routine types of questions to be
answered quickly without the need for an office
visit
� Test results can be provided efficiently, along with follow-up
instructions and medication information
� Follow-up can be done after an office visit, as well as
clarification or explanation of information that was
provided during an office setting after the patient is home
� Links can be provided for helpful articles or websites that can
help answer questions
Communicating by e-mail has many advantages, but there are
some important considerations of which it is important
to be aware. The use of e-mail technology must be balanced
with patient confidentiality and the patient’s right to
privacy. HIM professionals can assist in developing policies and
procedures for use of e-mail as well as the patient
portal to ensure that patient rights are met, while still allowing
for efficient use of technology to enhance patient care.

If using e-mail to communicate with patients, it must be
encrypted to ensure that it is secure.
Scheduling Appointments
Scheduling patient appointments is an essential part of daily
work for healthcare providers, from small family
practices to large multi-specialty clinics, in all types of care
settings, including physician offices and hospital outpatient
departments. Customer service representatives or medical
receptionists may schedule patients for all types of dental
visits, optometrists, surgeons, psychiatrists, and any other type
of general medical or specialist appointment.
Scheduling can get rather complex if the doctor is practicing in
multiple clinics or sees patients at more than one
medical facility. Appointments need to be well coordinated and
the support staff must be kept abreast of all new
patients or any changes in provider schedules.
One way patient scheduling can be simplified is with the use of
an online scheduling tool as a part of a patient portal.
Regardless of size, medical practices can allow patients to self-
schedule medical appointments via an online portal or
use of other online scheduling software. Many medical offices
have already established portals, and the addition of
online scheduling is a great feature that can enhance patient
convenience and reduce the need for office staff to
manually appoint patients to the provider’s schedule.
Some patients may want to be able to schedule appointments
around the clock even when the provider’s office is
closed or when phone lines are busy. Increasingly, patients do
not have time to schedule appointments during
business hours.
Patients may be given the option of requesting an appointment

online via the patient portal, and then waiting to be
offered an appointment time from the scheduling staff.
Alternatively, patients may be allowed to schedule their own
appointments directly into the provider’s system after viewing
openings in the schedule. Healthcare organizations can
manage how the online appointment system is used by
implementing a variety of system controls that limit or
maximize capability for self-scheduling.
Building and managing a patient portal requires HIM expertise
and knowledge. HIM professionals are responsible
for the integrity of the healthcare record, and the creation of the
record of care starts at the time the appointment is
made. It is essential that HIM professionals get involved in
portal functionality design from the moment patients sign
up to access the portal through the patient’s actual use of the
portal and for all of its intended purposes.
HIM a Key Player in Consumer Engagement
Greater patient engagement ultimately contributes to better
outcomes, and health information management
professionals play a key role in supporting patient engagement.
HIM professionals can prepare healthcare providers
to connect with patients and caregivers through adoption and
management of patient portals, encouraging the use of
secure e-mail for provider communications, facilitating and
supporting online scheduling software, and helping
develop policies and procedures to assist with the adoption of
other emerging technologies.
Additional Resources
For further reading on this topic, please see the following
additional resources from AHIMA:

� Assessing and Improving EHR Data Quality (Updated)
� Appendix B: Vendor Questionnaire for EHR System Selection
� Integrity of the Healthcare Record: Best Practices for EHR
Documentation
� Rules for Handling and Maintaining Metadata in the EHR
� Managing Copy Functionality and Information Integrity in
the EHR
� Evolving ROI Specialists into Health Record Ambassadors
Notes
1 Centers for Medicare and Medicaid Services. “EHR Incentive
Programs: The Official Web Site for the Medicare
and Medicaid Electronic Health Records (EHR) Incentive
Programs.” June 29, 2015. www.cms.gov/Regulations-
and-Guidance/Legislation/EHRIncentivePrograms/index.html.
2 HealthIT.gov. “Standards and Certification Regulations:
Clinical Quality Measures.” www.healthit.gov/policy-
researchers-implementers/clinical-quality-
measures#quality_measure_code_sets.
3 Medicare.gov. “Hospital Compare.”
www.medicare.gov/hospitalcompare/search.html?
AspxAutoDetectCookieSupport=1.
4 HealthIT.gov. “Patient Ability to Electronically View,
Download, and Transmit Health Information.” February 24,
2014. www.healthit.gov/providers-professionals/achieve-

meaningful-use/core-measures-2/patient-ability-
electronically-view-download-transmit-vdt-health-information.
5 Rulon, Vera. “Obtaining Quality Healthcare through Patient
and Caregiver Engagement.” Journal of AHIMA 86,
no. 1 (January 2015): 48-51.
6 “Health IT SmartBrief Special Report: Connected Care.”
Health IT SmartBrief. April 8, 2015.
www2.smartbrief.com/servlet/ArchiveServlet?issueid=FD150D6
3-D306-43F6-92FC-
9BBC6418F5A9&lmid=archives.
7 Baldwin, Kevin et al. “The Implementation and Management
of Patient Portals.” Journal of AHIMA 86, no. 4
(April 2015): 50-55.
8 AHIMA. “Preparing for a Doctor’s Visit: A Reference Guide
for Patients, Caregivers, and Advocates.”
http://myphr.com/Resources/MX10172%20Patient%20Resource
%20Guide_FINAL.pdf.
9 AHIMA. “Understanding Your Medical Record.” 2015.
www.myphr.com/HealthLiteracy/understanding.aspx.
10 Crawford, Mark. “Declassifying Doctors’ Notes.” Journal of
AHIMA 84, no. 5 (May 2013): 22-25..
11 Centers for Medicare and Medicaid Services. “Emergency
Medical Treatment and Labor Act (EMTALA).”
March 26, 2012. www.cms.gov/Regulations-and-
Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA
/.

Prepared By
Lesley Kadlec, MA, RHIA
Annessa Kirby
Heidi Shaffer, RHIA
Paula Warren, RHIA
Acknowledgments
Lucia Aschettino, CHTS-CP, CHTS-IM, CHTS-TR, HITPRO-CP
Patricia Buttner, RHIA, CDIP, CHDA, CCS
Susan Casperson, RHIT
Susan Clark, RHIT, CHTS-IM, CHTS-PW
Marlisa Coloso, RHIA, CCS
Angie Comfort, RHIA, CDIP, CCS
Jane DeSpiegelaere, MBA, RHIA, CCS, FAHIMA
Karen Gibson, RHIA, FAHIMA
Laurie Miller, RHIT, CCS-P
Angela Rose, MHA, RHIA, CHPS, FAHIMA
Donna J. Rugg, RHIT, CCS
Alisha R. Smith, MS, RHIA, CHPS
Lou Ann Wiedemann, MS, RHIA, CDIP, CHDA, CPEHR,
FAHIMA
Article citation:
Kadlec, Lesley; Kirby, Annessa; Shaffer, Heidi; Warren, Paula.
"HIM Best Practices for
Engaging Consumers in Their Overall Healthcare" Journal of
AHIMA 86, no.9 (September 2015):
50-56.

GSST 1S
Spring, 2020
Paper #1
What does it mean to say that sex, gender, and sexuality are
socially constructed? In
your response, be sure to explain/define key terms you are using
and to integrate
meaningfully at least three course readings assigned since the
start of the quarter. You
are encouraged to include examples or ideas from other course
materials, such as
lessons or videos, and from your personal experiences, as well.
You may include
outside materials, but you are not expected to.
Papers will be evaluated using the following criteria:
of what it means
to say sex, gender, and sexuality are socially constructed?
nd
concepts?

course readings
assigned since the start of the quarter?
material to make
their argument?
clearly and coherently?
-on and
incomplete sentences,
verb/noun incongruence, and other writing problems?
-spaced pages using a
reasonable (11-12
point) font and no smaller than 1” margins?
-text citations (Steinem 1978) for
works cited?
Please submit your paper no later than Saturday, April 25th, at
6pm via the iLearn site
for your discussion section.
Common Questions about Papers
May I use the first person (“I”) voice?
Yes, please do! We want to hear your voice.
What is meaningful incorporation of a course reading?
Meaningful incorporation means using a reading in such a way
that reflects your
understanding of the content and that advances the argument
you are making. As
much as possible, use your own words rather than quote directly
from the reading. This
helps convey your understanding of the material. Be sure to also

use those readings
that make the most sense for the argument you are making in
your paper.
1
This content is protected and may not be shared, uploaded, or
distributed without the express
permission of the author. © 2020 Katja M. Guenther, University
of California, Riverside
[email protected]
Week Two
Lesson Two
The Truth about Truth (& Anthony)
Becoming grounded in the field of Gender & Sexuality Studies
benefits greatly from
learning a bit about the history of women and sexual minorities
in the United States.
While most students are aware that women in the US did not
have the right to vote
until 1920, fewer students are familiar with many of the other
limitations placed on
women, with how women (and allies) have organized to resist
these limitations, and
what the changing experiences of sexual minorities have been
across US history. As we

move through the quarter together, we will be reading some
historical documents that
help illuminate the lived experiences of women and sexual
minorities, as well as their
efforts at resistance. In many cases, these documents serve the
dual function of
showing concepts we are talking about in class in action in real
life.
Last week, we talked about the First Wave of feminist activism
in the United States,
which originated in the early 1800s and which focused on
women’s right to vote. It is
highly likely that you have heard the name Sojourner Truth
before, and you may have
read her famous “Ain’t I A Woman?” speech. Maybe you
noticed that the speech we
read for class this week doesn’t include the phrase, “Ain’t I a
woman?” That’s because
Truth’s speech at the 1851 Ohio Women’s Rights Convention
was not recorded. The
most accurate record of her speech is believed to be that
documented by her good
friend Reverend Marius Robinson, who was present when she
gave the speech and who
took notes on it; he published his transcript of her speech just a
month after she gave
it. More than a decade later, white feminist and abolitionist
Frances Grange published
“Ain’t I A Woman,” changing the words significantly and
writing the speech as if it had
been spoken by a woman with the stereotypical accent of a
southern Black slave. In
fact, Sojourner Truth was Afro-Dutch; her first language was
Dutch, and she was born
and raised in New York state. She didn’t start learning English

until she was at least 11
years old, and spoke English with a heavy Dutch accent, not a
southern one (she never
lived in the American South).
Please read, look at the images, and listen to the videos about
the life of Sojourner
Truth available through the National Women’s History Museum
https://www.womenshistory.org/exhibits/sojourner-truth
As you are watching/reading/listening, pay attention to what is
new to you about
Sojourner Truth:
“Ain’t I a Woman?” speech was made
up by someone
else?
speech resonated so
much with American feminists across generations?
2
[email protected]
(Last year, during the GSST 1S lecture, a student commented
that Truth also removed

her shirt during her 1851 speech, which I found to be a
surprising claim; I subsequently
researched this and learned it was a myth propagated by trans
activist Laverne Cox
(and maybe others). For a woman to remove her clothing in
public—let alone at a
suffragist meeting—during this era would have been widely
documented and discussed;
there is no historical evidence to even hint that this ever
happened. Why do you think it
would matter if it did or did not happen?).
Susan B. Anthony is probably another familiar name to you.
Born in
Massachusetts in 1820, and spending most of her life as a
resident of New York,
Anthony was a white woman who opposed slavery and
advocated for women’s rights.
She became involved in the abolition movement as a teenager,
was a member of the
Underground Railroad network that helped Black slaves escape
the American South to
Canada, and became one of the most visible leaders of the
suffrage movement. She
was a rousing speaker, and she supported herself entirely by
giving paid lectures on
issues like abolition, temperance,1 and suffrage. Anthony
became best friends with
Elizabeth Cady Stanton, another white woman leader of the
suffrage movement;
Stanton, who lived with her husband and their seven children,
dedicated a bedroom in
her home to Anthony, and biographers of both women note that
they spent more time
with each other than with any other human being in their
lifetimes. (There is sometimes
also innuendo that Anthony and Stanton were lovers—I am not

aware of concrete
evidence to support this, although there is compelling historical
evidence that Anthony
was a lesbian who had sexual/romantic relationships with at
least two other women in
the suffrage movement. Most who have studied her life see
Anthony as “married” to her
work rather to relationships. See Lillian Faderman’s book To
Believe in Women: What
Lesbians Did for America for a compelling account of the many
contributions of lesbian
women to social progress in 19th and early 20th century
America). While Anthony was
excited to be alive when slavery ended, she died fourteen years
before American
women were granted the right to vote.
Stanton was a controversial figure. She was unusually
outspoken as a woman for
her era, she never married or had children (as women were
expected to do), and she
appeared regularly in public, advocating for the rights of Blacks
and women. She
1 The temperance movement sought to restrict/ban the
production and sale of alcohol in the US in
the mid-18th and early-19th centuries. Temperance was seen as
a women’s issue both because at that
time women were understood to be the moral guardians of their
husbands and children and because
women were so often victimized by men who drank. If they
were married to a man with a drinking
problem, women could not seek protection from physical abuse,
stop men from gambling away the
family’s funds, nor seek divorce with any ease. If they did

manage to get their husband to initiate
divorce, they were almost guaranteed to lose custody of their
children and to lose their income.
Alcoholism was also a leading contributor to men abandoning
their wives and/or having extra-marital
affairs that resulted in the birth of out-of-wedlock children.
Drinking alcohol was thus seen as a serious
social issue and one that had unique effects for women. Thanks
in large part to the organizing of women
temperance activists, the production and sale of alcohol was
banned in the US in the period known as the
Prohibition from 1920 until 1933.
3
[email protected]
routinely received death threats, and often traveled with two
armed guards. In 1850,
Anthony was arrested for casting a false ballot as she voted in
the November election,
seventy years before women won the right to vote. Reading #17
documents her speech
to the judge.
In 2019, leaders in New York announced that they would be
unveiling a statue of
Susan B. Anthony and Elizabeth Cady Stanton in New York
City’s Central Park. The
statue would be only the 6th statute in New York City to feature

women, whereas over
150 public statues in New York City feature men; there are 23
statues featuring men in
Central Park, and this will be the first statue in the park to
feature women. There was
an immediate outcry that the statue failed to represent the
diversity of the suffrage
movement, and the statue was redesigned to include Sojourner
Truth (Truth was a
frequent visitor to Stanton’s home, as was Anthony, but it’s
unknown if Truth and
Anthony ever knew each other). You can see a picture of the
planned statue (which I
believe will be in bronze) here:
https://www.theguardian.com/us-
news/2019/oct/21/new-york-central-park-first-sculpture-
honoring-women
Self-Assessment (not to be submitted, just for your own
reflection; best completed
after completing the reading)
1. Why in her argument with Judge Hunt does Susan B. Anthony
state that she
cannot get a trial by a jury of her peers (see top of second
column, page 126)?
2. What do Sojourner Truth and Susan B. Anthony seem to have
in common? What
about their life experiences and beliefs seem to have been
different?
3. How is the lack of statues of women in New York City and in
Central Park
evidence of patriarchy? What elements of patriarchal structure

that Johnson
discusses are evident in this underrepresentation?
4. What arguments would you make in favor of including
Sojourner Truth in the
final statue design?
distributed without the express permission
of the author. © 2020 Katja M. Guenther, University of
California, Riverside [email protected]
Week Four
Lesson One
Intersectionality
A core concept from the field of Gender & Sexuality Studies is
that of
intersectionality. As discussed in some of this week’s lecture
videos, intersectionality
refers to perspectives that integrate gender and other systems of
inequality. Feminist
women of color in the United States, as well as white women
who were poor and/or
lesbian, were among the first to articulate intersectional
perspectives, writing about
their experiences as oppressed in society because of their
gender, their race, and/or
their class. Reflecting back on Sojourner Truth’s statement of

1851 shows us that
intersectional thinking is hardly new.
During the Second Wave Women’s Movement, lesbian women,
disabled women,
Black women, Chicanx women, Asian American women, and
women who were poor or
working class began integrating their identities and experiences
as members of these
social categories with feminism. The Combahee River
Collective’s Statement, Audre
Lorde’s work on multiple oppressions, and Gloria Anzaldúa’s
writings on mestiza
consciousness that we are reading for this week are but some
examples of a rich terrain
of intersectional writing from the Second Wave. These writings
illuminated how the
experiences of many individuals and groups could not be
analyzed or understood
accurately if only looking at them as grounded in a single social
structure (like gender);
instead, multiple structures (like gender, race, and class) needed
to be considered.
Some of these writers—starting especially with white working
class and poor
women—also began articulating the idea of a feminist
standpoint. Drawing on the work
of Karl Marx (remember him? The German social theorist who
brought us the social
theories that undergird socialism and communism?), who argued
that members of the
working class see the world from a different perspective than
people in power (who he
called the bourgeoisie), feminist standpoint theorists began
asserting that women see

the world and develop knowledge from a different starting point
than their oppressors,
men. Anzaldúa’s idea of mestiza consciousness also articulates
a standpoint theory in
which the mestiza has a particular vantage point from which to
see gender relations,
tensions of race, ethnicity, and nationality, and more. By the
1980s, Black women
scholars were also articulating the idea of a Black feminist
standpoint.
Intersectionality was first articulated as a perspective in the
early 1990s, when
two Black women scholars in two different fields of study began
talking about the
interconnections between systems of structural oppression as a
lens or prism through
which to understand the social world and generate new
knowledge. These women—
UCLA Law Professor Kimberlé Crenshaw and University of
Maryland Sociology Professor
Patricia Hill Collins—are widely seen as the originators of
intersectional feminist
analysis. Crenshaw and Collins drew on both their experiences
as Black women, and
their knowledge (from research and observation) of Black
women’s lives to introduce a
new vocabulary that recognizes that structures of domination
and oppression in
society—whether based on gender, race, class, sexuality,
nationality, dis/ability—are

interlocking and support one another. Crenshaw referred to this
as “intersectionality;”
Collins initially used the language of a “matrix of domination.”
Today, the overwhelming majority of feminist scholarship is
intersectional.
Research and theorizing about gendered structures, lives, and
identities considers how
gender intersects with other axes of oppression and identity to
shape individual and
group experiences. Feminist scholars take as a starting point
that, “Expectations for
what constitutes femininity and masculinity, along with the
options available to different
women and men are deeply affected by sexism, poverty, racism,
homophobia,
cisheterosexism, and other cultural constraints and expectations.
To understand
people’s identities and opportunities, we need to understand the
privilege or oppression
that they experience, the historical times and circumstances in
which they are currently
living, the structural arrangements that surround their lives, and
the possibilities for
empowerment that they encounter or create” (Disch 2009: 32).
Intersectional perspectives recognize that at some moments—
whether in the
experiences of an individual or of an entire category of
people—one particular axis of
oppression may be most salient. In much of her activism since
2010, Prof. Crenshaw,
for example, has been critical of the #BlackLivesMatter
movement for failing to
acknowledge or mobilize around Black women who were killed
by police officers. Here,

Crenshaw notes that although these women share the same
racial category as men
who have been killed by police officers, their gender renders
them invisible and outside
of the framework of who people think of when they imagine
“victims” of police violence.
But in the context of their interactions with police, we can
assume that their race was
particularly salient.
Prof. Crenshaw was raised by parents who were active in the
Civil Rights
Movements. In this movement, women were sidelined by male
leaders, often given
diminished roles and credit for their work, and the concerns of
Black women were never
(and in many ways have yet to be) integrated into the politics of
civil rights. Thus, in
the context of the internal organization of the Civil Rights
Movement, gender is
particularly important for understanding the experiences of
Black women. When Black
women engaged with the Second Wave Feminist Movement,
they often found their
perspectives as Black women were sidelined. For instance,
while white women were
significantly focused on increasing the social acceptance of
women working outside of
the home, many Black women did not see working outside of
the home (which they had
been doing for generations) as a pathway to emancipation. In
this context, then, their
race was often very salient.
Intersectionality also drives our attention towards how
structures of inequality
work together. When we look at particular social institutions,
we can see intersectional

processes at work that help maintain existing structures of
power and domination. For
example, the system of Black slavery in the United States was a
system of racial
oppression (white people were allowed, by law, to treat and
trade Black people as
property), a system of class oppression (white capitalists
exploited the unpaid labor of
Black slaves for their own profit), and a system of gender
oppression (Black women
were denied the right to control their own bodies or
reproduction, and Black men were
prevented from protecting their families in ways considered
normal and appropriate for
men; both Black men and women had little or no choice over
their family formation or
the conditions of their labor). Slavery thus was a system of
racial-class-gender
oppression—and the racial and gender logics worked to prop up
and justify the gender
oppression, the gender and class logics worked to prop up the
racial oppression, and
the racial and gender logics worked to prop up the class
oppression.
Intersectional perspectives are now employed in understanding
the experiences
and identities of many different groups, including those of
dominant groups, such as

whites and men. In fact, scholarship on masculinities and on
whiteness routinely uses
an intersectional lens. Many of our readings in this course will
employ intersectional
perspectives, including (by way of some examples) work that
examines the experiences
of Latinx immigrants negotiating US immigration law, of low-
income trans people of
color, of Latinx sex workers in a poor country, of Native
American women activists, and
more. As we keep reading in the class, keep a keen eye out for
moments of
intersectional analysis. Ask yourself what would be lost in those
moments if we only
considered one dimension of structural oppression.
1. Identify your gender, race, class , and sexuality (using
whatever terms feel
comfortable to you). Then make two columns, one in which you
list a privilege
associated with your identities along each of these axes and one
in which you list
a penalty. Consult with McIntosh (#9) if needed.
2. When you are done with #1, identify at least one penalty and
one privilege your
experience that can be explained better by thinking about your
race, class,
gender, and/or sexuality together than thinking about them in
isolation (it’s okay
to focus on an intersection of just two, but if you can think
about an intersection
of three or more, that’s even better!)
3. Develop an intersectional hypothesis about the current

COVID crisis.
[email protected]
GSST 1
Week Two
Lesson One
Patriarchy
You’ve probably noticed by now that our major concept this
week is patriarchy.
In the Johnson reading and the YouTube lecture, you are
introduced to what patriarchy
is and how it operates as a social system. Historically, the term
“patriarchy” referred to
social systems in which the father or the oldest man in a kinship
group held power over
the family or tribe. In Greek, patriarchy literally means “rule of
the father;” only in the
mid-twentieth century did the word take on the broader meaning
of an institutionalized
pattern of men’s dominance in society. Many patriarchal
societies are also patrilineal,
which means that inheritance follows men’s ancestry and that
usually only men can
inherit (this continues to be true in many parts of the world;
while in the US it is no
longer legally true, in cultural practice, men tend continue to

hold power in many
families and many of our marriage rituals—such as women give
up their own names
and taking that of their husband, or a father “giving away” a
daughter by walking her to
a marriage ceremony—are a relic of when women were men’s
property).
The origins of patriarchy have been subject to historical
scholarship, and there
are multiple (and generally contradictory) explanations of when
and how patriarchy
developed. Some archeologists have found evidence that male
hierarchies emerged
when eastern Europeans (Ukrainians) invaded southern and
central Europe as early as
7000 BC. Some historians trace the roots to several millennia
later (4000 BC) when the
concept of fatherhood took root. Another theory on the
development of patriarchy,
advanced by feminist historian Gerda Lerner, is that patriarchy
developed between 3000
and 600 BC in the Middle East when tribes began trading
women as a way to build
bonds of loyalty across groups of people. This practice had
social benefits for increasing
a sense of social solidarity across groups of people and reducing
the likelihood of
warfare, but it also established the idea that women could be
traded away without their
consent, and that men had rights to self-determination that
women do not have—the
seed of patriarchal ideologies that are still with us today. Karl
Marx and his collaborator
Friedrich Engels assert that patriarchy developed in tandem
with the rise of private

property (particularly as an outcome of the domestication of
animals): Marx and Engels
argued that once people had private property such as a herd of
animals, they needed a
way to pass that property on across generations, but could not
do so unless men
controlled women’s reproduction; otherwise, how would you
know whose kid was
whose? So women were forced into monogamy. In The Origins
of Patriarchy (1884),
Engels described the development of patriarchy in terms many
Second Wave and
contemporary feminists would echo: A wife was to be ruled by
her husband, “reduced
to servitude,” and “the slave of his lust and a mere instrument
for the production of
children.” The creation of patriarchy, Engels concluded,
constituted “the world historical
defeat of the female sex.”
[email protected]
No “initiating event” has been identified for patriarchy; that is,
historians have
not found conclusive evidence that something specific happened
(like an environmental
or demographic change) to push humans in this direction.
The Second Wave Feminist Movement brought new attention to
the idea of
patriarchy, moving it from a technical term used by scholars to

a more widely used term
with which many Americans became familiar. Fighting
patriarchy became an organizing
goal of the Second Wave, which found evidence of patriarchy in
virtually all major social
institutions: family, religion, economy, politics, education,
sports, arts and culture.
Through consciousness raising (see last week’s lessons), the
Second Wave helped
women identify patterns of patriarchy in their own lives.
Consciousness raising also
worked to help women identify and stop their own internalized
sexism, a type of
internalized oppression through which girls and women
internalize (or take on, accept,
or believe) sexist ideologies and start enacting sexism and
misogyny on themselves and
other women and girls. Read about some examples of her own
internalized sexism that
one young woman notices here:
https://feministcampus.org/ways-we-have-internalized-
misogyny/
One of the goals of feminism has been to support people in
unlearning
patriarchy. That is, starting with the Second Wave feminist
movement, feminism has
worked to help all people rethink their own systems of
knowledge and belief to identify,
problematize, and ideally ultimately purge patriarchal
ideologies. This is no easy feat,
and undoing patriarchy can be a lifelong project. Read this blog
post at Everyday
Feminism to get some ideas about how to start unlearning
patriarchy.
https://everydayfeminism.com/2014/10/unlearning-patriarchal-
lies/

In this recent column in UC Berkeley’s student newspaper, a
fellow UC student
discusses her experience trying to unlearn patriarchy:
https://www.dailycal.org/2019/03/29/unlearning-the-patriarchy/
As the course progresses and we delve more into different
expressions of gender
inequality, try to keep patriarchy in mind. Think about what the
rules and expectations
are for girls and boys, women and men, and how they differ and
what the
consequences of those differences are.
As you contemplate patriarchy, also note how patriarchy is
linked to
homophobia: same-sex desire is problematic precisely because
it violates patriarchal
expectations of sexual relations in which a man dominates a
woman and in which men’s
pleasure/desire is most important. Further, there is no room in
patriarchy for people
who don’t fit clearly into one of the two gender categories on
which patriarchy relies,
man or woman—a topic we will talk about more in Weeks
Three, Four, and beyond. In
fact, some scholars of gender inequality have now replaced
using the term patriarchy
with either the term heteropatriarchy or even
cisheteropatriarchy, in large part to
emphasize how powerholders are cisgender, heterosexual men
who, as a group,
dominate cisgender women and sexual minorities (including
gays and lesbians, trans,
intersexual, and non-binary persons) as a group.

[email protected]
reflection; best completed
after reading Johnson #2 and completing the first of the videos
for Week Two)
1. Write your own definition of patriarchy, using your own
words.
2. What has patriarchy meant in your own life? Identify 2-3
ways in which
patriarchy has shaped your opportunities, the expectations
others have for you
or that you have for yourself, and/or your beliefs.
3. Commit to trying to unlearn one patriarchal practice you
engage in for a month.
This could be something like changing something you say (such
as committing to
no longer use the term “you guys”), turning off any TV show
that centers on
violence against women and girls (when I tried doing this, I
learned I had to give
up the entire genre of detective/crime shows!), or letting go of a
patriarchal
belief you have about yourself or others (such as fatphobia).
Stick to it and
report back on Piazza how you are doing with your challenge.

Week Three
Lesson One
The Social Construction of Sex & Gender
The first lecture video for this week goes into some detail about
how and why scholars in the field of Gender & Sexuality
Studies (and many other disciplines, including Sociology,
Anthropology, Ethnic Studies, and Philosophy) generally view
sex and gender as socially constructed. Social constructs are
probably useful in human societies because they allow people to
makes sense of the world through categories that have
meanings. Many parts of social life are constructed—money,
borders, government/the state, and more! To say something is
socially constructed does not mean that it is fake or
insignificant; social constructs are incredibly real and can have
serious implications for individuals, groups, and entire
societies.
Social constructs share a few core features, and thinking about
them can help us understand sex and gender as social constructs
better. Social constructs are constituted by social relations (and
by definition can only exist within social relations), such if the
social relations were different, it would be possible for the
specific social constructions not to exist at all, or to exist in a
very different way. Social constructs generally also develop
over time—most have long historic roots—and they can change
over time as social relations within a society change. That is
good news, because it means we can change them!
Many of you in this course are likely familiar with two or more
cultures, and you may even see how sex and gender are socially
constructed differently across those cultures. Just one simple
example: in Germany, where my family lives, women regularly
wear their hair very short (well above the ear). When I am in
Germany, I never have issues with people categorizing me as

male or as a man—people see my short hair and they keep
looking for other social cues of my sex and gender, such
physique, clothing, accessories, etc., before addressing me as
Fraulein (Ms.) or Herr (Mr.). In the United States, women rarely
wear their hair very short, and those who do are often assumed
to be lesbian or otherwise gender-non-normative. I routinely
have people (who are presumably women, since they’re in a
room marked as designated for women) inform me that I have
walked into to the “wrong” gender bathroom, or just do a
double-take and then flee (this especially happens to me in
bathrooms designated for women on the UCR campus!). I am
called “Sir,” by wait staff and others. This doesn’t happen every
day, but a good amount—and far, far more than it happens than
when I am home in Germany. That’s because my appearance
falls outside of the expected gender expression of women in the
US and closer to the expected gender expression of men,
whereas my appearance falls within the expected gender
expression of women in Germany.[footnoteRef:1] These are
differences in how gender is socially constructed in these two
societies. (I know my hair may not look that short on my videos
lately, but like many of us, I haven’t gotten a haircut in ages
because of the pandemic, and I am struggling with whether to
trust my wife to do it. ). I have no doubt that you can come up
with examples from your own lives of similar examples. [1:
Gender expression refers to how an individual communicates
their sex/gender to others within the norms and expectations of
a particular society. So, for example, in the US, having long
hair, carrying a purse, and wearing shoes with heels are
associated with femininity and would typically be part of
expressing the gender identity of a woman.]
Another key point to make about social constructionist theories
is that they are not all the same. There are many different
theorists writing and working in this area, and they often have
somewhat different ideas. Some focus on the micro, or
interactional, level of analysis, so how we create and recreate

constructs through our everyday interactions with other people.
Others focus more on how macro, or larger-scale institutions,
like the state and the economy, (re)create social constructs and
use those constructs to guide how they function.
Sex and gender difference are constructed and maintained at
three levels: 1) at the individual level of social learning; 2) at
the interactional level of social relations in everyday life (e.g.,
interactions with friends, family, religious leaders, teams, etc.);
and 3) at the level of structural, organizational and institutional
forces that constrain and shape action (adapted from Aulette and
Wintner, 2015). Importantly, social constructions of sex and
gender can vary across or even within these three levels. For
example, you may be a player on an athletic team that has a
particular way of thinking about, enacting, and embodying sex
and gender, while being part of a student club that has a
somewhat different way of thinking about, enacting, and
embodying sex and gender. One of the two may have more rigid
norms around sex and gender, the other more flexible norms.
You may even find some groups that challenge dominant
constructions of sex and gender and which offer very different
ways of thinking about the possibilities of these categories.
As we move through the quarter, we will be talking both about
more social constructs (such as masculinity and femininity), and
about how our social construction of sex, gender, sexuality—
often in conjunction with other socially constructed structures
of inequality like race—shape individual, group, and societal
experiences. Keep an eye for opportunities to think about sex
and gender as socially constructed.
In regards to sex and gender, a key idea for this week (and to
keep with us for the rest of the quarter) is that the social
constructionist perspective stands in opposition to biological
determinism and gender essentialism. Biologically deterministic
perspectives hold that a person’s sex characteristics determine
their gender identity and expression. Gender essentialism
further explains people’s behaviors and identities as being an
outcome of their sex/gender category. For instance, if you’ve

ever heard someone say girls and women are more emotional or
have a harder time controlling their emotions than boys and
men, that would be a biologically deterministic and gender
essentialist statement: the statement claims that someone’s
behavior is the outcome of their gender, and that all (or at least
most) people in that gender category will exhibit this behavior.
reflection; best completed after completing the reading)
1. Compare two contexts in your life in which you encounter
different (whether just a little bit or very different is fine!)
social constructions of sex and gender.
2. Practice thinking about and analyzing social constructs.
Beauty is socially constructed. Explain how, in your own words.
3. How does the existence of gender diverse people challenge
biological determinism?
distributed without the express permission of the author. © 2020
Katja M. Guenther, University of California, Riverside
[email protected]

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