NRE C.A.R.E.S. Framework™

1. Purpose of the C.A.R.E.S. Framework™

The NRE C.A.R.E.S. Framework™ is an evidence-informed analytical framework developed by NRE Health Institute in 2026 to examine whether physical, social and organisational conditions support women's ability to access environments and participate in activities on their own terms.

It was created to address an important distinction between an opportunity being theoretically available and that opportunity being realistically usable by women under conditions that support agency, dignity and appropriate safety.

C.A.R.E.S. examines five interconnected areas: Choice, Autonomy, Respect, Environment and Safety. Together, they provide a structured way of identifying conditions that may support participation, restrict it or require further consideration.

The framework can be applied across many different settings, including workplaces, public spaces, recreation, healthcare, transport, sport, community environments and leisure settings. It may also be applied to naturist environments, but it is not a naturism-specific framework.

2. Why C.A.R.E.S. exists

Access to a potentially beneficial environment does not necessarily mean that the environment is realistically usable by every woman.

A place may provide opportunities for physical activity, contact with nature, recreation, social participation or recovery while other conditions make that opportunity difficult, uncomfortable, impractical or undesirable to use.

The difference matters because environmental opportunity and usable opportunity are not the same thing.

A simple example

An urban park may provide green space, walking opportunities, daylight, recreation and contact with nature.

Those characteristics may make the park potentially supportive of health and wellbeing.

Yet a woman's practical ability or willingness to use the same park may also be influenced by factors such as:

• lighting and visibility;
• time of day;
• transport availability;
• isolation or crowd conditions;
• access to toilets or other facilities;
• previous experiences within the location;
• harassment or intimidation concerns;
• availability of assistance if something goes wrong.

The physical health opportunity may therefore exist while practical access to that opportunity remains constrained.

The gap C.A.R.E.S. addresses

Existing environmental assessments often focus primarily on the qualities of a place, service or activity.

C.A.R.E.S. adds another layer by examining the conditions surrounding participation.

It asks whether those conditions support meaningful choice, preserve autonomy, demonstrate respect, provide an appropriate environment and address relevant safety considerations.

Why a dedicated framework is needed

These questions are not fully answered by the other NRE frameworks.

The NRE Health & Wellbeing Matrix™ can examine relationships between people, activities and physical or environmental conditions. The 11 Levels framework describes body and clothing exposure configurations. SSM examines stigma-related attitudes and perceptions. NSNMS investigates motivations for engaging with or avoiding non-sexual nudity.

C.A.R.E.S. has a different role.

It examines whether the broader physical, social, organisational and temporal conditions surrounding an activity support a woman's practical ability to make and act upon her own decisions.

3. The five C.A.R.E.S. domains

The NRE C.A.R.E.S. Framework™ is built around five domains: Choice, Autonomy, Respect, Environment and Safety.

Each domain examines a different aspect of the conditions surrounding participation. They are related, but they should not be treated as interchangeable.

A setting may perform strongly in one domain while remaining weak or uncertain in another. For that reason, C.A.R.E.S. keeps each domain visible rather than reducing the framework to a single overall judgement.

The domains work together

The five domains are designed to be examined together because practical participation is rarely determined by a single factor.

For example, an activity may technically offer choice, but that choice may be weakened if withdrawing leads to persistent pressure. A facility may have strong privacy arrangements, but poor transport access may still constrain practical use. An environment may be well designed physically, but inappropriate behaviour may undermine respect and safety.

C.A.R.E.S. therefore looks at the combined conditions surrounding participation while preserving the distinct role of each domain.

No domain automatically overrides the others

C.A.R.E.S. does not assume that a strong result in one domain compensates for a material weakness in another.

For example, excellent facilities do not remove concerns about coercion. Strong organisational policies do not automatically establish respectful behaviour in practice. A setting that offers meaningful choice may still require attention to safety or privacy.

4. C · Choice

Choice is the first domain of the NRE C.A.R.E.S. Framework™ because participation cannot meaningfully be described as being on a woman's own terms if realistic alternatives are absent.

C.A.R.E.S. distinguishes between a choice that exists in theory and one that can reasonably be exercised in practice.

Simply presenting several options does not necessarily establish meaningful choice. The practical consequences, accessibility and conditions attached to those options also matter.

What Choice examines

Depending on the environment or activity being assessed, relevant considerations may include:

• whether participation is optional;
• whether non-participation is a realistic alternative;
• whether different forms or levels of participation are available;
• whether a woman can change an earlier decision;
• whether reasonable alternatives are practically accessible;
• whether relevant information is available before a decision is made;
• whether declining an optional activity produces inappropriate disadvantage;
• whether rules or procedures unnecessarily restrict available alternatives.

Choice must be meaningful

A nominal choice can become ineffective when one option carries disproportionate pressure, disadvantage or practical difficulty.

For example, an organisation may describe an activity as voluntary while creating social or organisational consequences for people who decline. Alternatively, a facility may technically provide several options while only one is realistically accessible.

C.A.R.E.S. therefore examines the practical conditions attached to the available choices, rather than relying solely on how those choices are described.

Choice can change

A decision does not necessarily become permanent because participation has begun.

Where reasonably possible within the activity and circumstances, a woman should be able to reconsider her participation, modify it or withdraw. C.A.R.E.S. therefore examines whether the environment recognises that decisions can evolve as circumstances, information or personal preferences change.

Choice does not require unlimited options

C.A.R.E.S. does not require every environment or organisation to accommodate every possible individual preference.

Legal requirements, legitimate operational needs, physical limitations, professional obligations and the rights or safety of other people may reasonably restrict available options.

The assessment question is whether the choices that remain are genuine, proportionate and reasonably usable within the context being examined.

5. A · Autonomy

Autonomy concerns a woman's ability to exercise control over her own participation.

While Choice examines whether meaningful alternatives exist, Autonomy examines whether a woman can actually decide between those alternatives for herself.

An environment may appear to provide choice while social pressure, organisational expectations, manipulation or other influences undermine the independence of the decision.

What Autonomy examines

Depending on the environment or activity, relevant considerations may include:

• whether participation is genuinely voluntary;
• whether relevant information is available for informed decision-making;
• whether decisions can be made without coercion or intimidation;
• whether persistent or inappropriate pressure is present;
• whether personal boundaries can be established and communicated;
• whether those boundaries can subsequently be changed;
• whether participation can reasonably be modified;
• whether consent can be withdrawn where consent is relevant;
• whether a participant can reasonably leave or disengage;
• whether personal information and privacy remain appropriately controlled.

Autonomy is continuing

C.A.R.E.S. treats autonomy as an ongoing condition rather than a single decision made at the beginning of an activity.

Agreeing to participate does not mean agreeing to every subsequent interaction, condition or change that may occur.

Where consent is relevant, consent to one activity should not automatically be interpreted as consent to another. Likewise, an earlier decision should not automatically prevent a woman from reconsidering her participation when circumstances change.

Pressure can take different forms

Pressure does not need to involve an explicit threat to affect autonomy. Depending on the circumstances, it may be social, interpersonal, organisational or economic.

C.A.R.E.S. therefore considers whether apparently voluntary participation is accompanied by conditions that may make refusal or withdrawal unreasonably difficult.

This does not mean that every expectation, rule or consequence constitutes coercion. Workplaces, healthcare settings, sporting activities and other environments may have legitimate requirements.

The relevant question is whether those requirements are appropriate to the context and whether optional participation is genuinely treated as optional.

Autonomy and personal boundaries

Autonomy also includes the ability to establish boundaries around personal interaction, privacy, physical proximity, photography or recording, and other relevant aspects of participation.

The precise boundaries will vary between individuals and environments. C.A.R.E.S. does not prescribe what those boundaries should be. It examines whether the environment provides reasonable conditions for boundaries to be communicated and respected.

Autonomy is not isolation

Exercising autonomy does not mean making decisions without information, advice or interaction with others.

People routinely seek professional guidance, discuss decisions with partners, families or colleagues, and consider organisational requirements. These influences do not inherently remove autonomy.

The distinction is whether the final decision remains meaningfully the woman's own within the circumstances in which it is made.

6. R · Respect

Respect examines the interpersonal and organisational conditions surrounding participation.

An environment may provide meaningful choice and preserve autonomy while still becoming difficult to use if participants experience harassment, unwanted attention, disregard for boundaries, invasions of privacy or objectifying behaviour.

C.A.R.E.S. therefore treats respect as a distinct condition of meaningful participation.

What Respect examines

Depending on the environment or activity, relevant considerations may include:

• whether personal boundaries are recognised;
• whether consent is sought where consent is required;
• whether refusal or withdrawal of consent is respected;
• whether privacy is appropriately protected;
• whether interpersonal behaviour preserves dignity;
• whether harassment, intimidation or degrading behaviour is addressed;
• whether unwanted sexualisation or objectification is addressed;
• whether photography, filming or recording practices respect consent and applicable rules;
• whether communication is respectful;
• whether concerns can be raised without inappropriate retaliation or dismissal;
• whether organisations respond appropriately when boundaries are breached.

Respect for boundaries

Personal boundaries differ between individuals and may also change according to the activity, environment and circumstances.

C.A.R.E.S. does not attempt to establish one universal set of personal boundaries for all women.

Instead, it examines whether reasonable boundaries can be communicated and whether other participants, staff or organisations appropriately recognise them.

Respect and consent

Consent is relevant whenever an interaction requires another person's agreement.

Consent to enter an environment or participate in an activity should not automatically be interpreted as consent to unrelated physical contact, photography, recording, sexual attention or other interactions requiring separate agreement.

Where consent is required, C.A.R.E.S. examines whether the surrounding conditions support consent being meaningfully given, refused and, where applicable, withdrawn.

Privacy and photography

Cameras and recording devices can materially affect how an environment is experienced, particularly where people may reasonably expect enhanced privacy or control over their image.

A C.A.R.E.S. assessment may therefore examine whether photography and recording rules are clear, communicated and appropriately enforced, and whether individuals retain reasonable control over being photographed or recorded where the circumstances require consent.

Applicable privacy, surveillance, photography and recording laws vary between jurisdictions. C.A.R.E.S. does not replace those legal requirements.

Respect without sexualisation

Women should not automatically be sexualised because of their clothing, appearance, body, location or participation in a particular activity.

This distinction is particularly relevant in environments involving bodies, changing, swimming, healthcare, sport, wellness or non-sexual nudity.

Participation in such an environment does not itself establish consent to sexual attention, sexual behaviour or objectification.

Respect must exist in practice

Written policies can support respectful environments, but policies alone do not establish that respectful conditions exist.

Where possible, a C.A.R.E.S. assessment should distinguish between formal rules and how those rules operate in practice, including whether concerns are taken seriously and whether identified problems are appropriately addressed.

7. E · Environment

Environment examines the wider conditions within which participation occurs.

C.A.R.E.S. does not treat an environment simply as a physical location. A woman's experience of the same place can be influenced by its design, the people present, organisational practices and the time at which it is used.

The Environment domain therefore considers four interacting dimensions: physical, social, organisational and temporal conditions.

Physical environment

The design and condition of a location can influence whether an activity is realistically accessible and usable.

Depending on the setting, relevant considerations may include:

• layout and physical accessibility;
• entrances, exits and routes through the environment;
• lighting and visibility;
• toilets and sanitation;
• changing or privacy facilities where relevant;
• shelter and protection from environmental conditions;
• maintenance and cleanliness;
• seating or rest facilities where appropriate;
• transport access;
• communication availability;
• emergency access and evacuation routes.

Social environment

The people using or managing an environment can substantially influence whether it feels practically usable.

Relevant considerations may include:

• expected standards of behaviour;
• interactions between participants, visitors and staff;
• harassment, intimidation or unwanted attention;
• inclusiveness and social acceptance;
• crowding or isolation;
• availability of assistance;
• whether inappropriate behaviour is challenged or tolerated.

The same physical environment can therefore operate very differently depending on its social conditions.

Organisational environment

Where an organisation manages an activity or location, its policies, procedures and practices may materially affect participation.

Relevant considerations may include:

• clear rules and participant information;
• staffing arrangements;
• staff training where appropriate;
• privacy procedures;
• reporting and complaint mechanisms;
• responses to incidents or inappropriate behaviour;
• supervision where appropriate;
• accessibility arrangements;
• scheduling and operating practices;
• responsibility and accountability for identified problems.

C.A.R.E.S. distinguishes between the existence of a written policy and evidence that the policy is communicated and implemented in practice.

Temporal environment

An environment should not automatically be assumed to provide the same conditions at every time of day, day of the week or season.

Relevant temporal considerations may include:

• daytime versus nighttime conditions;
• opening and closing times;
• staffing at different hours;
• public transport availability;
• changes in pedestrian or visitor activity;
• periods of increased isolation or crowding;
• shift schedules;
• seasonal weather and daylight changes;
• availability of services or assistance at particular times.

The same place can produce different assessments

A location that is highly usable during one period may become substantially less usable under different conditions.

For example, a public park may have good transport connections, substantial pedestrian activity and clear visibility during daylight hours. Late at night, transport frequency, lighting, staffing, visibility and the number of other users may be different.

C.A.R.E.S. therefore allows an assessment to be specific to the place, activity, time and circumstances being examined.

Environment and individual variation

The existence of supportive environmental conditions does not establish that every woman will experience or use an environment in the same way.

Mobility, disability, pregnancy, caring responsibilities, transport availability, cultural context, previous experiences and individual preferences may affect practical use.

Where such differences are relevant and supported by appropriate evidence, they should be recognised rather than assuming the existence of a single representative female experience.

8. S · Safety

Safety examines whether relevant risks associated with an environment or activity have been recognised and whether reasonable measures exist to address them.

C.A.R.E.S. does not define safety as the complete absence of risk. Everyday environments and activities involve varying degrees of risk, and no framework can guarantee that an adverse event will not occur.

Instead, the Safety domain considers whether reasonably foreseeable concerns have been identified, assessed and appropriately managed within the context being examined.

What Safety examines

Relevant considerations will depend on the environment and activity but may include:

• physical hazards;
• safe access to and departure from the environment;
• lighting and visibility;
• availability of emergency assistance;
• emergency communication;
• transport conditions;
• isolated areas or periods of reduced activity;
• workplace hazards where applicable;
• harassment, intimidation or personal-safety concerns;
• safeguarding arrangements where applicable;
• incident reporting procedures;
• emergency and evacuation procedures;
• responses to known or identified hazards.

Physical safety

Physical safety concerns may arise from the location itself, the activity being undertaken or changing environmental conditions.

Depending on the context, this may include terrain, surfaces, equipment, traffic, weather, temperature, water, workplace hazards, poor maintenance, inadequate lighting or restricted emergency access.

C.A.R.E.S. does not replace specialist occupational, recreational, environmental or other professional risk assessments where these are required.

Personal safety

Safety can also be affected by interpersonal and situational conditions.

Relevant factors may include isolation, unwanted attention, harassment, intimidation, the availability of staff or assistance, transport options, visibility and the ability to leave an environment.

These conditions may change significantly according to location and time, which is why the Safety and Environment domains should be considered together while remaining separately assessed.

Perceived and documented safety conditions

Women's decisions about using an environment may be influenced both by documented conditions and by their perception of personal safety.

C.A.R.E.S. should not automatically treat either as equivalent to the other. Where possible, an assessment should distinguish between available evidence about hazards or incidents and reported experiences, concerns or perceptions.

Both may be relevant to understanding practical participation, but they represent different forms of information and should be identified accordingly.

Safeguarding

Some environments or activities may require specific safeguarding arrangements because of the people involved, the nature of the activity or applicable legal and organisational responsibilities.

Where safeguarding obligations apply, a C.A.R.E.S. assessment may examine whether appropriate arrangements exist, but it does not replace formal safeguarding policies, professional standards or statutory requirements.

Safety measures should remain proportionate

Safety should not automatically be used as a justification for removing women's autonomy or unnecessarily restricting participation.

Measures intended to address risk should, where practicable, be proportionate to the identified concern and should consider whether the same objective can be achieved without unnecessarily limiting Choice or Autonomy.

This is an important interaction within C.A.R.E.S.: improving Safety should not automatically mean reducing agency.

No guarantee of safety

A favourable C.A.R.E.S. Safety assessment cannot guarantee that an environment is safe or that no accident, crime, harassment or other adverse event will occur.

The assessment describes identified conditions at the time and within the scope of the assessment. Conditions may subsequently change.

9. C.A.R.E.S. assesses conditions, not women

A fundamental principle of the NRE C.A.R.E.S. Framework™ is that the subject of assessment is the conditions surrounding participation, not the woman making the decision.

C.A.R.E.S. is not designed to determine how a woman should think, feel, behave or participate. Nor does it attempt to define a single acceptable level of comfort, confidence or risk for all women.

What C.A.R.E.S. does not determine

A C.A.R.E.S. assessment should not be used to conclude that a woman:

• should participate in an activity;
• should decline participation;
• should feel safe because an environment has been assessed favourably;
• should accept a particular level of risk;
• should tolerate behaviour that makes her uncomfortable;
• should dress or present herself in a particular way;
• should disclose personal information;
• should adopt a particular lifestyle or identity;
• should participate in naturism;
• should avoid naturism.

Different decisions can be equally legitimate

Two women presented with substantially the same environmental conditions may make different decisions.

One may choose to participate. Another may participate with modifications. Another may decide that the activity or environment is not appropriate for her at that time.

Those different outcomes do not, by themselves, indicate that one woman has assessed the situation correctly and another incorrectly.

Individual circumstances, responsibilities, preferences, experiences and perceptions may legitimately influence decisions.

Avoiding paternalism

A framework intended to support women's participation can become counterproductive if safety or wellbeing is used to unnecessarily restrict women's choices.

C.A.R.E.S. therefore seeks to identify and address environmental barriers rather than assuming that women themselves should be restricted in response to those barriers.

Where a legitimate risk requires restrictions, those restrictions should be based on the nature of the risk, applicable responsibilities and proportionate risk management rather than assumptions about women as a group.

No single female experience

Women are not a homogeneous population, and C.A.R.E.S. should not create a hypothetical “average woman” against whom every environment is judged.

Relevant circumstances may include:

• age and life stage;
• disability, mobility or accessibility requirements;
• pregnancy or caring responsibilities;
• work arrangements;
• transport availability;
• geographic location;
• cultural and social context;
• previous experiences;
• the specific activity being undertaken;
• individual preferences and boundaries.

These factors should only be incorporated into an assessment when they are relevant to its defined scope and supported by appropriate information or evidence.

The framework evaluates what can be changed

By focusing on environmental and participation conditions, C.A.R.E.S. directs attention towards factors that organisations, communities, designers, employers, service providers and other responsible parties may be able to improve.

Better lighting, clearer information, appropriate privacy arrangements, alternative participation options, respectful conduct, accessible reporting procedures or improved transport arrangements are examples of conditions that may sometimes be changed.

The objective is therefore not to instruct women how to adapt themselves to an environment, but to examine whether the environment can better support meaningful participation.

10. How to conduct a C.A.R.E.S. assessment

A C.A.R.E.S. assessment should examine a clearly defined environment, activity or situation rather than making broad conclusions without specifying the circumstances being assessed.

The assessment process is designed to identify supportive conditions, constraints, uncertainties and opportunities for improvement across the five C.A.R.E.S. domains.

Step 1 · Define the environment

Identify the specific place, organisation, service, activity or situation being assessed.

The description should be sufficiently precise for another reader to understand what the assessment covers.

Depending on the application, this might be a workplace, public park, recreation facility, healthcare setting, transport environment, community activity or naturist venue.

Step 2 · Define the intended activity or use

Identify what the woman is realistically expected or able to do within the environment.

The same location may produce different assessments for different activities. Walking through a park, exercising there, attending an event and working there are not necessarily equivalent forms of use.

Step 3 · Define relevant conditions

Record contextual factors capable of materially changing the assessment. Depending on the situation, these may include:

• time of day;
• duration of participation;
• day of the week or season;
• staffing arrangements;
• transport availability;
• access and departure arrangements;
• facilities available;
• expected participant numbers;
• applicable policies or rules;
• relevant environmental conditions.

Step 4 · Examine each C.A.R.E.S. domain

Assess each domain separately:

• Choice: Are meaningful and realistic alternatives available?
• Autonomy: Can decisions be made and changed without inappropriate pressure?
• Respect: Are dignity, consent, privacy and boundaries appropriately respected?
• Environment: Do physical, social, organisational and temporal conditions support the intended activity?
• Safety: Have relevant and reasonably foreseeable risks been appropriately addressed?

Conclusions should not be transferred automatically from one domain to another. Evidence that supports Environment, for example, does not by itself establish that Respect or Autonomy is also supportive.

Step 5 · Identify enabling conditions

Record features that support realistic participation.

These may include accessible facilities, meaningful alternatives, clear information, appropriate privacy arrangements, respectful behaviour, reliable transport, effective reporting procedures or other relevant conditions.

Step 6 · Identify constraints

Record conditions that may restrict participation, reduce practical choice or create barriers within one or more C.A.R.E.S. domains.

Constraints should be described specifically. Broad labels should be avoided where the underlying condition can be identified more precisely.

Step 7 · Identify possible improvements

Where a constraint is identified, the assessment may consider whether a reasonable and proportionate change could improve the conditions.

Recommendations should correspond to the identified issue rather than attempting to redesign an environment around assumptions about women.

Where several responses are possible, preference should generally be given to approaches that improve conditions while preserving Choice and Autonomy wherever reasonably practicable.

Step 8 · Record evidence and uncertainty

A C.A.R.E.S. assessment should make clear what information supports its conclusions.

Where relevant, information should be distinguished between:

• directly observed conditions;
• documented policies or procedures;
• research or official evidence;
• participant-reported experiences;
• incident or operational information legitimately available;
• professional or organisational assessments;
• assumptions or interpretations;
• information that remains unknown.

Where evidence is insufficient, the assessment should say so rather than filling the gap with an unsupported conclusion.

Step 9 · Record the assessment date and scope

Conditions can change. Staffing, facilities, policies, transport, management, surrounding development and patterns of use may all alter over time.

A formal C.A.R.E.S. assessment should therefore record when it was conducted and clearly define its scope.

A previous assessment should not automatically be treated as describing current conditions where material changes may have occurred.

11. C.A.R.E.S. assessment classifications

The NRE C.A.R.E.S. Framework™ uses a condition-based classification for each of its five domains rather than assigning an overall numerical score.

This approach is deliberate. Choice, Autonomy, Respect, Environment and Safety represent different aspects of participation, and a significant weakness in one domain should not disappear inside an average produced by stronger results elsewhere.

Classification requires explanation

A classification should not normally appear without an explanation of the conditions and evidence supporting it.

For example, describing Safety as “Partially supportive” provides little useful information unless the assessment also identifies which conditions are supportive, which limitations remain and what evidence was considered.

No automatic overall classification

C.A.R.E.S. does not automatically combine the five domains into a single overall classification.

A setting could, for example, produce the following result:

Reporting the domains separately preserves the Safety constraint rather than allowing four stronger classifications to obscure it.

Why C.A.R.E.S. does not use a percentage score

A numerical result such as “82% C.A.R.E.S. compliant” could imply a level of measurement precision that the framework has not established.

It could also create misleading comparisons between environments with substantially different strengths, weaknesses, activities and conditions.

At its current stage of development, C.A.R.E.S. therefore prioritises transparent domain-level analysis over numerical ranking.

Classification is context-specific

A classification applies to the environment, activity, conditions and time period defined by the assessment.

It should not automatically be extended to different activities, times or populations without considering whether the relevant conditions remain substantially the same.

For example, the Environment or Safety classification of a public space during daylight hours may differ from an assessment of the same location late at night.

Classification is not certification

A Supportive classification does not certify that an environment is safe, legally compliant, accessible to every woman or suitable for every individual.

Likewise, a Constrained classification does not establish that no woman can or should use the environment.

The classifications describe identified conditions within the stated scope of a C.A.R.E.S. assessment. They do not prescribe individual decisions.

12. How C.A.R.E.S. fits within NRE

The NRE C.A.R.E.S. Framework™ has a specific role within the wider NRE framework ecosystem.

NRE frameworks have been developed to examine different questions. They may complement one another, but they should not be treated as interchangeable or used outside their intended purpose.

11 Levels

The NRE 11 Levels framework describes body and clothing exposure configurations across different circumstances.

It answers a fundamentally different question from C.A.R.E.S. C.A.R.E.S. does not rank clothing states or determine an appropriate level of bodily exposure.

NRE Health & Wellbeing Matrix™

The NRE Health & Wellbeing Matrix™ examines relationships between people, activities and physical or environmental conditions that may influence health and wellbeing.

C.A.R.E.S. adds a different analytical layer by examining whether the conditions surrounding access and participation support women's agency and practical use of that environment.

SSM · Standardised Stigma Measure

SSM examines stigma-related attitudes and perceptions. It can help investigate how stigma may affect attitudes towards bodies, non-sexual nudity or participation.

C.A.R.E.S. does not measure stigma. Where stigma affects practical participation, however, relevant evidence may help inform the assessment of particular C.A.R.E.S. conditions.

NSNMS · Non-Sexual Nudity Motivations Study

NSNMS investigates motivations associated with engaging with or avoiding non-sexual nudity.

C.A.R.E.S. does not attempt to determine why a woman chooses naturism, non-sexual nudity or any other activity. Its concern is whether the surrounding conditions support her ability to make and act upon that decision on her own terms.

BELONG FREE

BELONG FREE addresses participation without compulsory membership, registration, fees or prescribed organisational identity.

C.A.R.E.S. is different. It assesses the conditions surrounding women's participation regardless of whether that participation occurs within a formal organisation, an informal group or independently.

The specific role of C.A.R.E.S.

This distinction gives C.A.R.E.S. a defined role rather than duplicating existing NRE work.

It also allows evidence generated through other NRE research or frameworks to inform a C.A.R.E.S. assessment where relevant without changing the purpose of either framework.

A complementary framework ecosystem

Used appropriately, the frameworks can examine different dimensions of the same situation.

For example, a naturist environment could potentially be examined through:

• 11 Levels to describe the body or clothing exposure configuration;
• the Health & Wellbeing Matrix™ to examine relevant physical and environmental health conditions;
• SSM to investigate stigma-related attitudes and perceptions;
• NSNMS to investigate motivations for participation or avoidance;
• C.A.R.E.S. to examine whether the surrounding conditions support women's agency and practical participation.

The existence of several frameworks therefore does not mean that the same question is being assessed repeatedly. Each framework provides a different analytical lens.

13. C.A.R.E.S. and the NRE Health & Wellbeing Matrix™

The NRE C.A.R.E.S. Framework™ and the NRE Health & Wellbeing Matrix™ are designed to examine different but complementary dimensions of an environment.

The distinction is important. An environment may contain characteristics associated with opportunities for health and wellbeing while social, organisational or practical conditions affect whether women can realistically access and use those opportunities.

What the Matrix examines

The NRE Health & Wellbeing Matrix™ considers relationships between the person, activity and physical or environmental conditions.

Depending on the environment being assessed, this may include factors associated with:

• contact with natural environments;
• opportunities for physical activity;
• daylight exposure;
• air and environmental conditions;
• thermal conditions;
• noise;
• location and setting;
• the nature of the activity being undertaken.

What C.A.R.E.S. adds

C.A.R.E.S. does not reassess those environmental characteristics as health outcomes.

Instead, it examines whether the surrounding conditions make access and participation realistically available to women on acceptable terms.

This may involve examining:

• whether meaningful alternatives exist;
• whether participation remains voluntary;
• whether privacy and personal boundaries are respected;
• whether facilities support practical use;
• whether social behaviour affects participation;
• whether organisational arrangements create barriers;
• whether conditions change according to time;
• whether relevant safety concerns are appropriately addressed.

Example · An urban park

Consider an urban park containing substantial green space, walking paths, areas for physical activity and opportunities for contact with nature.

The Matrix may examine characteristics of the park that are relevant to health and wellbeing.

A separate C.A.R.E.S. assessment could examine:

• Choice: whether different routes, activities or practical alternatives are available;
• Autonomy: whether women can use the space without inappropriate pressure or interference;
• Respect: whether harassment, unwanted attention or other boundary violations affect participation;
• Environment: whether lighting, toilets, accessibility, transport, social conditions and time of use support practical access;
• Safety: whether relevant hazards and personal-safety considerations have been appropriately addressed.

The two assessments could therefore reach different but compatible conclusions.

The park might present substantial environmental opportunities while the C.A.R.E.S. assessment identifies particular constraints affecting its practical use at certain times or under certain conditions.

Time can change the result

This distinction becomes particularly important when conditions vary throughout the day.

A park may provide the same trees, paths and physical layout at midday and late at night, while lighting, transport, staffing, surrounding activity and patterns of use change substantially.

The environmental opportunity may remain present, but the conditions affecting practical access may have changed.

Example · A workplace

The same principle can be applied to workplaces.

Environmental analysis may identify daylight, movement, rest, noise, thermal or other conditions relevant to health and wellbeing.

C.A.R.E.S. can separately examine whether work arrangements provide meaningful options where applicable, preserve autonomy and dignity, provide suitable facilities and address relevant safety conditions.

For night workers, this may require particular attention to temporal conditions such as staffing, transport, isolation, access to facilities and conditions surrounding arrival and departure.

Neither framework replaces the other

A strong Matrix assessment does not automatically produce a strong C.A.R.E.S. assessment.

Equally, supportive C.A.R.E.S. conditions do not establish that an environment provides particular health benefits.

The frameworks should therefore remain analytically separate even when they are applied to the same environment.

14. Applying C.A.R.E.S. in different environments

The NRE C.A.R.E.S. Framework™ is not restricted to a single activity, industry or lifestyle. Its five domains can be applied wherever physical, social, organisational or temporal conditions may influence women's practical ability to participate on their own terms.

The factors examined should always be adapted to the actual environment and activity. The examples below illustrate possible applications rather than creating universal requirements for every setting.

Workplaces

In a workplace, C.A.R.E.S. can examine conditions surrounding women's practical participation in work, facilities, scheduling and workplace systems.

Relevant considerations may include:

• availability of reasonable options where genuine alternatives exist;
• ability to raise concerns without inappropriate pressure or retaliation;
• respectful workplace behaviour;
• privacy and appropriate facilities;
• workplace layout and accessibility;
• staffing and supervision arrangements;
• reporting procedures;
• safe access to and departure from the workplace;
• relevant occupational hazards.

C.A.R.E.S. does not replace workplace health and safety law, employment obligations, industrial requirements or professional risk assessment.

Night work

Night work demonstrates why the temporal dimension of C.A.R.E.S. can be important.

The physical workplace may remain substantially unchanged while surrounding conditions differ considerably from daytime operations.

An assessment may therefore consider:

• staffing during night hours;
• access to facilities and assistance;
• lighting around entrances, exits and parking areas;
• public transport availability;
• isolated work areas;
• arrival and departure arrangements;
• reporting and emergency communication systems;
• relevant fatigue-management arrangements.

Public parks and green spaces

Parks and green spaces may offer opportunities for movement, recreation, social activity and contact with nature.

C.A.R.E.S. can examine whether surrounding conditions support realistic use of those opportunities.

Relevant factors may include accessibility, route design, toilets, lighting, visibility, transport, patterns of use, maintenance, available assistance and differences between daytime and nighttime conditions.

Gyms, swimming centres and recreation facilities

In sporting and recreational environments, C.A.R.E.S. may examine:

• participation options;
• accessibility;
• changing and privacy arrangements;
• staff and participant behaviour;
• photography and recording practices;
• complaint and reporting procedures;
• facility design;
• relevant physical and personal-safety conditions.

The objective is not to prescribe how women should exercise, swim, dress or use facilities. It is to examine whether the conditions surrounding participation provide meaningful and respectful options.

Healthcare environments

Healthcare can involve particularly significant questions of bodily autonomy, privacy, communication and informed decision-making.

Depending on the circumstances, C.A.R.E.S. may examine whether:

• information is communicated appropriately;
• consent is sought where required;
• privacy and dignity are respected;
• reasonable preferences can be communicated;
• the physical environment supports privacy and accessibility;
• concerns can be raised;
• relevant safety procedures are present.

C.A.R.E.S. does not replace clinical judgement, informed-consent requirements, professional standards, healthcare regulation or medical decision-making.

Transport and mobility environments

Access to an activity can depend on the journey required to reach and leave it.

C.A.R.E.S. may therefore consider transport where it materially affects practical participation.

Relevant conditions may include operating hours, waiting areas, lighting, accessibility, connections between transport and the destination, availability of assistance and conditions during early-morning or late-night travel.

Community and social activities

Community participation can be affected by both formal rules and informal social expectations.

C.A.R.E.S. may examine whether participation is genuinely optional, whether different levels of involvement are possible, whether boundaries are respected, how inappropriate behaviour is handled and whether the environment is practically accessible.

Naturist environments

Naturist environments are one possible application of C.A.R.E.S., but they do not define the framework.

In a naturist setting, a C.A.R.E.S. assessment may examine:

• whether participation is genuinely voluntary;
• whether applicable clothing or nudity expectations are clearly disclosed before participation;
• whether a woman can make an informed decision about entering the environment;
• whether personal boundaries are respected;
• whether unwanted sexualisation or objectification is addressed;
• whether photography and recording rules are clear;
• whether privacy arrangements are appropriate to the setting;
• whether reporting mechanisms exist where relevant;
• whether physical and personal-safety conditions are appropriately addressed.

Home and private environments

Some C.A.R.E.S. principles may also be relevant within private or domestic environments, particularly where activities involve multiple people.

Choice, autonomy, consent, privacy and personal boundaries remain relevant principles, although the appropriate assessment method may differ substantially from that used for workplaces or public facilities.

The framework travels, the assessment changes

The five C.A.R.E.S. domains remain constant across applications, but the questions, evidence and relevant conditions should change according to the environment being examined.

A workplace should not be assessed as though it were a park. A healthcare environment should not be assessed as though it were a recreational facility. A naturist venue should not be assessed as though its defining activity were irrelevant.

Context is therefore essential to responsible use of the framework.

15. Evidence standards and responsible interpretation

The NRE C.A.R.E.S. Framework™ is intended to support structured, evidence-informed analysis. Conclusions should therefore be based on the best information reasonably available for the environment and conditions being assessed.

C.A.R.E.S. should not be used to convert assumptions, stereotypes or isolated impressions into statements of fact.

Potential sources of evidence

Depending on the assessment, relevant information may include:

• peer-reviewed research;
• government publications and official statistics;
• recognised standards and professional guidance;
• applicable legislation or regulatory requirements;
• organisational policies and procedures;
• direct observations of environmental conditions;
• structured surveys or consultation;
• participant-reported experiences;
• incident information where legitimately available;
• accessibility, safety or environmental assessments;
• operational information relevant to the defined assessment.

Different evidence answers different questions

Not all evidence should be treated as interchangeable.

Official incident data may provide information about recorded events. Participant surveys may provide information about experiences or perceptions. Direct observation may establish whether particular facilities or environmental features were present at a specific time. Organisational policies may establish formal requirements.

Each source should be used for the question it can reasonably support.

Policy is not necessarily practice

The existence of a policy can be relevant evidence, but it does not by itself establish how an environment operates in practice.

For example, an organisation may have a written anti-harassment, photography, privacy or reporting policy. A C.A.R.E.S. assessment may also need to consider whether that policy is communicated, accessible and implemented where the available evidence permits such an assessment.

Reported experiences matter, but require accurate description

Women's reported experiences can provide important information about barriers, behaviour, perceived safety, accessibility and practical participation.

Such information should be described accurately. A reported perception should not automatically be presented as proof of an independently verified hazard, just as an absence of recorded incidents should not automatically establish that every participant experiences an environment as safe or supportive.

Avoid generalising from individual cases

A single experience may identify an important issue, but it does not necessarily establish how all women experience an environment.

Where conclusions are based on limited evidence, that limitation should remain visible.

C.A.R.E.S. should not use isolated examples to make unsupported claims about entire organisations, communities, professions, locations or groups.

Record uncertainty

Responsible assessment includes acknowledging what is not known.

Where relevant evidence is missing, outdated, conflicting or too limited to support a conclusion, the appropriate classification may be Insufficient information.

This is not a failed assessment. It identifies an evidence gap that may need further investigation.

Evidence can change

Environments are not static. Management, infrastructure, staffing, policies, transport, surrounding development and patterns of use can change.

Research and official evidence may also develop over time.

C.A.R.E.S. conclusions should therefore be dated and reconsidered when material changes occur or significant new evidence becomes available.

Avoid unsupported causal claims

An association between a condition and an outcome does not automatically establish that the condition caused the outcome.

C.A.R.E.S. assessments should avoid causal language unless the available evidence reasonably supports it.

Where evidence indicates an association, concern, barrier or potential influence, the wording of the assessment should reflect that level of evidence.

Evidence hierarchy should remain context-sensitive

Peer-reviewed research and official evidence may be particularly valuable for general claims, but local environmental conditions may require direct observation or operational information.

A high-quality C.A.R.E.S. assessment may therefore combine several forms of evidence rather than relying on a single source.

16. Limitations and boundaries of C.A.R.E.S.

The NRE C.A.R.E.S. Framework™ provides a structured method for examining conditions surrounding women's participation. Like any analytical framework, it has defined limits and should be used only for the purpose for which it was developed.

A C.A.R.E.S. assessment describes identified conditions within a defined context. It does not establish how every woman will experience that environment or what decision any individual should make.

C.A.R.E.S. is not a health measurement

C.A.R.E.S. does not measure physical health, mental health, wellbeing, fitness, illness or clinical outcomes.

A Supportive C.A.R.E.S. classification therefore does not mean that an environment is medically beneficial or appropriate for every individual.

C.A.R.E.S. is not a diagnostic or clinical instrument

The framework is not designed to diagnose medical or psychological conditions and should not be represented as a clinical screening, diagnostic or therapeutic instrument.

Healthcare decisions should remain subject to appropriate professional standards, clinical judgement and applicable regulation.

C.A.R.E.S. does not guarantee safety

No assessment can guarantee that an accident, crime, harassment, inappropriate behaviour or other adverse event will not occur.

A favourable Safety classification means only that the identified conditions and available evidence support that classification within the defined scope and at the time of assessment.

C.A.R.E.S. is not a legal compliance audit

C.A.R.E.S. may consider legislation, regulations or recognised standards where they are relevant to an assessment, but the framework does not determine legal compliance.

Legal requirements vary between jurisdictions and may change over time. Questions requiring legal interpretation should be addressed through appropriately qualified legal or regulatory expertise.

C.A.R.E.S. does not replace specialist risk assessment

The framework should not replace occupational health and safety assessments, security assessments, accessibility assessments, safeguarding procedures, clinical assessments, engineering evaluations or other specialist processes where these are required.

C.A.R.E.S. may identify an issue requiring further specialist assessment. It should not claim to provide that specialist assessment itself.

C.A.R.E.S. does not certify an organisation or environment

A C.A.R.E.S. assessment should not automatically be described as certification, accreditation, endorsement or approval by NRE Health Institute.

Terms such as “C.A.R.E.S. certified,” “NRE approved” or “guaranteed women-safe” should not be used unless NRE Health Institute establishes a separate formal certification programme with defined governance, assessment and quality-control procedures.

C.A.R.E.S. does not represent all women

Women have different circumstances, experiences, preferences, boundaries and accessibility requirements.

A framework can identify environmental conditions and recurring barriers, but it cannot produce a universal description of how all women will respond to them.

Conclusions should therefore remain specific to the evidence, population and circumstances actually examined.

C.A.R.E.S. does not prescribe participation

The framework does not establish participation as the preferred outcome.

A woman may decide to participate, participate differently, postpone participation or decline entirely. C.A.R.E.S. does not rank those decisions.

Conditions can change after assessment

A C.A.R.E.S. assessment represents conditions within a particular scope and period.

Changes in management, staffing, facilities, policies, surrounding infrastructure, transport, patterns of use or other relevant conditions may alter the assessment.

Formal assessments should therefore include an assessment date and, where appropriate, a review date or review trigger.

The framework itself may evolve

C.A.R.E.S. was developed by NRE Health Institute as an evidence-informed framework. Its methodology may be refined as research, consultation, practical application and independent evaluation provide additional evidence.

Material methodological changes should be documented through version control rather than silently replacing previous definitions or assessment criteria.

17. Development, validation and future research

The NRE C.A.R.E.S. Framework™ was developed by NRE Health Institute in 2026 as an evidence-informed analytical framework for examining conditions that may support or constrain women's ability to access environments and participate in activities on their own terms.

C.A.R.E.S. is an NRE-developed methodology. Its current status should be described accurately and transparently.

Current framework status

At its introduction, C.A.R.E.S. should be regarded as a structured analytical framework rather than an independently validated measurement instrument.

NRE Health Institute should not claim that C.A.R.E.S. has been clinically, psychometrically or independently validated unless future research specifically establishes such findings.

Similarly, the framework should not be described as an established international standard, regulatory methodology or universally accepted measure.

Evidence-informed development

The concepts represented within C.A.R.E.S., including autonomy, consent, dignity, environmental accessibility, safety and meaningful participation, intersect with established areas of research and professional practice.

However, the organisation of these concepts into the five-domain C.A.R.E.S. structure is an NRE Health Institute development.

References supporting individual concepts should therefore not be presented as evidence that an external researcher or institution has validated the complete C.A.R.E.S. Framework™.

Literature review

Continued development should include structured review of research relevant to each domain.

Areas for review may include:

• women's use of public and recreational spaces;
• perceived and documented safety conditions;
• environmental design and accessibility;
• workplace participation and occupational conditions;
• autonomy and informed decision-making;
• consent and personal boundaries;
• privacy and dignity;
• harassment and objectification;
• transport and temporal accessibility;
• healthcare environments;
• sport and recreation;
• organisational culture and reporting systems.

Stakeholder consultation

Future development may benefit from consultation with women using different environments as well as relevant researchers, practitioners, organisations and subject-matter specialists.

Consultation should seek variation in experience rather than assuming that a small group can speak for all women.

Pilot assessments

C.A.R.E.S. should be tested across substantially different environments to determine whether its definitions and assessment method remain usable outside the context in which the framework was initially developed.

Potential pilot environments could include:

• urban parks;
• workplaces;
• night-work environments;
• recreation facilities;
• healthcare settings;
• transport environments;
• community activities;
• naturist environments.

Inter-rater consistency

If C.A.R.E.S. develops into a formal assessment methodology, NRE Health Institute should examine whether different assessors using the same evidence reach reasonably consistent domain classifications.

Significant disagreement between assessors may indicate that definitions, evidence requirements or classification criteria require refinement.

Testing the domains themselves

Future research should also remain open to the possibility that the framework requires modification.

Research may show that some domains overlap excessively, require clearer boundaries or contain important subdomains that should be separately recognised.

The acronym should not prevent evidence-driven improvement of the methodology.

Future quantitative development

C.A.R.E.S. does not initially use an aggregate numerical score.

A quantitative instrument should only be considered if sufficient research establishes reliable questions, appropriate weighting, reproducibility and a defensible interpretation of the resulting values.

Numerical scoring should not be introduced merely because percentages appear simpler or more authoritative.

Independent review

Independent academic or professional review could strengthen future development by identifying assumptions, methodological weaknesses, missing evidence and opportunities for refinement.

Independent criticism should be documented and considered as part of the framework's development rather than treated as a threat to it.

Version control

Material revisions to C.A.R.E.S. should be assigned identifiable version numbers and dates.

This allows assessments to state which version of the framework was used and prevents later methodological changes from being retrospectively attributed to earlier assessments.

18. Responsible use and misuse prevention

The NRE C.A.R.E.S. Framework™ is intended to support structured analysis of conditions surrounding women's participation. Its usefulness depends on the framework being applied within its defined scope and described accurately.

Responsible use requires particular care to avoid turning a contextual analytical framework into a certification, ranking system, legal opinion, medical judgement or statement about what women should do.

Who may use the framework

C.A.R.E.S. may be used by NRE Health Institute, researchers, organisations, service providers, community groups, designers, employers, venue operators or other parties wishing to examine the conditions surrounding women's participation.

Use of the framework does not, by itself, imply endorsement, certification or approval by NRE Health Institute.

Permissible conclusions

A responsible C.A.R.E.S. assessment may identify:

• supportive conditions;
• partially supportive conditions;
• material constraints;
• insufficient information;
• specific environmental or organisational barriers;
• areas where additional evidence is required;
• reasonable opportunities for improvement.

Conclusions should remain tied to the defined scope, evidence and assessment date.

Claims that should not be made

Unless a separate formal process is established and appropriate evidence supports the claim, C.A.R.E.S. should not be used to describe an environment or organisation as:

• “C.A.R.E.S. certified”;
• “NRE approved”;
• “guaranteed safe for women”;
• “100% women-friendly”;
• “clinically validated”;
• “legally compliant”;
• “risk-free”;
• “suitable for all women.”

No use as a tool of coercion

C.A.R.E.S. should not be used to pressure women into participation by arguing that an environment has been assessed favourably.

A Supportive classification does not create an obligation to participate and should never be used to dismiss a woman's personal boundaries, preferences or decision not to take part.

No use to justify blanket restrictions

The framework should also not be used to justify unnecessary restrictions on women under the general label of safety.

Where a legitimate risk exists, the preferred response should be to identify and address the relevant condition where reasonably practicable, rather than automatically removing choice or access.

No unsupported reputational claims

A C.A.R.E.S. assessment should avoid broad claims that could unfairly damage the reputation of an organisation, venue, community or individual where the available evidence does not support such conclusions.

Identified concerns should be described specifically and objectively. Where information is disputed, incomplete or unverified, that uncertainty should be clearly stated.

Conflict of interest

Where the assessor has a material relationship with the organisation, venue or activity being assessed, that relationship should be disclosed where relevant to the credibility of the assessment.

Independent review may be appropriate for assessments intended for publication, formal comparison or significant organisational decision-making.

Use of trademarks and framework name

The name NRE C.A.R.E.S. Framework™ should be used in a manner that preserves the framework's defined meaning and does not imply NRE endorsement where none has been given.

Modified or derivative methodologies should not be represented as the official NRE C.A.R.E.S. Framework™ unless NRE Health Institute has adopted those modifications.

19. C.A.R.E.S. assessment template

The following structure provides a standard format for documenting an assessment using the NRE C.A.R.E.S. Framework™.

The template is intended to improve consistency and transparency. It should be adapted where necessary to the environment or activity being examined without changing the meaning of the five C.A.R.E.S. domains.

Assessment identification

Assessment scope

Clearly describe what the assessment includes and excludes.

C · Choice

A · Autonomy

R · Respect

E · Environment

S · Safety

Assessment summary

The summary should preserve all five classifications. They should not be converted into an average, percentage or aggregate score.

Key supportive conditions

Key constraints

Priority improvements

Evidence and uncertainty statement

Review

20. Formal framework definition and status

The following definition establishes the formal identity, purpose and boundaries of the NRE C.A.R.E.S. Framework™.

Formal definition

C.A.R.E.S. evaluates conditions surrounding participation rather than evaluating women themselves.

It examines five domains:

• Choice: whether meaningful and realistic alternatives are available.
• Autonomy: whether decisions can be made, maintained and changed without coercion, manipulation or inappropriate pressure.
• Respect: whether dignity, consent, privacy and personal boundaries are appropriately recognised.
• Environment: whether physical, social, organisational and temporal conditions appropriately support the intended activity.
• Safety: whether relevant and reasonably foreseeable physical hazards, personal-safety concerns and safeguarding conditions have been appropriately identified and addressed.

Purpose

The purpose of C.A.R.E.S. is to provide a structured method for examining the difference between an opportunity being theoretically available and that opportunity being realistically usable by women under conditions that support meaningful choice and agency.

The framework may be applied across workplaces, public spaces, healthcare, recreation, sport, transport, community settings, leisure environments and other contexts where conditions surrounding participation are relevant.

Naturist environments are one possible application of C.A.R.E.S., but C.A.R.E.S. is not a naturism-specific framework.

Framework status

Interpretation

A C.A.R.E.S. assessment describes identified conditions within its defined scope and according to the evidence reasonably available at the time of assessment.

It does not determine what an individual woman should choose and does not establish participation as the preferred outcome.

Participation, modified participation, postponement and non-participation may each represent legitimate exercises of individual choice.

A favourable assessment does not guarantee safety, wellbeing, legal compliance, accessibility for every individual or a positive experience.

Methodological commitment

NRE Health Institute may refine C.A.R.E.S. as research, consultation, practical application and independent evaluation provide additional evidence.

Material revisions should be documented through version control so that the methodology used for an assessment remains identifiable.

Claims concerning validation, reliability or effectiveness should advance only as far as supporting evidence permits.

Evidence & References Appendix

The NRE C.A.R.E.S. Framework™ was developed by NRE Health Institute in 2026. The framework itself is an NRE-developed methodology.

The research and institutional sources presented in this appendix support concepts incorporated within C.A.R.E.S., including women's autonomy, dignity, privacy, participation, environmental accessibility, perceived safety, harassment prevention and the influence of physical, social and temporal conditions.

1. Women's safety and use of public environments

Research supports the importance of considering more than the physical existence of a public space when examining whether women can realistically use it.

A 2025 systematic literature review by te Braak and van Tienoven examined women's perceived safety across urban public environments. The review synthesised 50 studies and identified interacting individual, social, environmental and temporal factors affecting women's perceptions of safety.

This is particularly relevant to the C.A.R.E.S. Environment domain because the framework deliberately distinguishes physical, social, organisational and temporal conditions rather than treating an environment simply as a location.

2. Built environment and perceived safety

A 2025 narrative review by Dubey, Bailey and Lee examined research on women's perceived safety in public places and public transport.

The review identified relationships involving built-environment, individual and social characteristics. It highlighted factors including street lighting and walking-path conditions and also identified the importance of social cohesion and community trust.

This evidence supports the C.A.R.E.S. principle that practical access cannot be assessed solely by asking whether a facility or public space technically exists.

3. Parks, physical activity and practical access

Research examining park use provides an example of the distinction between environmental opportunity and practical use that underpins C.A.R.E.S.

A study involving 3,213 park users across 48 parks in high-poverty neighbourhoods in Los Angeles examined gender, park characteristics, perceived crime and park use. The researchers identified gendered differences in park-based physical activity and examined perceived crime as a potential pathway affecting use.

Separate research in the same broader area has also reported gender disparities in park visitation, duration of visits and park-based physical activity.

4. Women's safety, mobility and public-space participation

UN Women's Safe Cities and Safe Public Spaces Global Initiative provides further institutional support for considering women's safety together with mobility and participation in public environments.

Its global work has addressed sexual harassment and other forms of sexual violence against women and girls in public spaces while seeking to improve women's sense of safety and autonomous mobility.

This supports the broader C.A.R.E.S. rationale that the practical usability of an environment can involve interactions between safety, autonomy, mobility and environmental conditions.

5. Dignity, privacy and consent in healthcare

The World Health Organization's standards for improving the quality of maternal and newborn care provide established examples of dignity, privacy, confidentiality and consent being treated as components of respectful healthcare.

WHO's standards include preservation of dignity, privacy and confidentiality and consideration of whether permission is sought before examinations or procedures.

These principles are relevant to the C.A.R.E.S. Autonomy and Respect domains, particularly when the framework is applied to healthcare or other environments involving bodily privacy and informed participation.

6. Violence and harassment in working environments

WHO occupational guidance recognises workplace violence and harassment as including physical, sexual, verbal and psychological abuse and workplace harassment.

Preventive approaches identified by WHO include recognising incidents and risks, improving work organisation, considering staffing and working time, reducing isolated work where appropriate and ensuring access to assistance.

These principles provide evidence relevant to the C.A.R.E.S. Respect, Environment and Safety domains when applied to workplaces.

Références

Evidence Base · Choice & Autonomy

Choice and Autonomy are separate but closely related domains within the NRE C.A.R.E.S. Framework™.

The distinction reflects established principles concerning informed decision-making, voluntariness, bodily autonomy and the ability to accept or refuse available options.

The evidence does not establish that C.A.R.E.S. itself has been independently validated. It supports the concepts incorporated within the Choice and Autonomy domains.

1. Bodily autonomy and women's decision-making

The United Nations Population Fund identifies bodily autonomy as an important component of gender equality and sexual and reproductive health and rights.

UNFPA describes bodily autonomy in terms of people's capacity to make decisions concerning their own bodies, personal lives and futures and emphasises women's and girls' ability to make their own decisions.

This provides institutional support for the central C.A.R.E.S. principle that women should remain the decision-makers regarding their own participation rather than having participation prescribed for them.

2. Informed consent requires more than a signature

The American College of Obstetricians and Gynecologists states that informed consent requires adequate, accurate and understandable information together with the ability to make an intentional and voluntary choice.

ACOG also notes that informed decision-making can include accepting or refusing recommended treatment.

Importantly, ACOG distinguishes the process of informed consent from the existence of a signed consent document. A signed form alone does not establish that a person's values and priorities were meaningfully considered.

This distinction supports the C.A.R.E.S. approach of examining practical conditions rather than treating formal documentation or stated policy as sufficient evidence of autonomy.

3. Alternatives are part of meaningful decision-making

ACOG's informed-consent guidance includes consideration of available alternatives and the consequences of accepting or declining recommended treatment.

This provides evidence for the distinction made within the C.A.R.E.S. Choice domain between an option merely existing and a person having meaningful alternatives from which to make a decision.

4. Voluntariness and freedom from coercion

Established medical-ethics guidance identifies voluntariness as an important component of informed consent and distinguishes voluntary decision-making from decisions affected by coercion, pressure or undue influence.

This principle is relevant beyond healthcare because C.A.R.E.S. examines whether apparently optional participation remains genuinely optional in practice.

The framework therefore considers whether social, interpersonal, organisational or other pressures may materially undermine a woman's practical ability to decline or modify participation.

5. Refusal is a legitimate decision

ACOG's guidance explicitly recognises refusal of care or treatment as a possible outcome of informed decision-making by an adult with decision-making capacity.

C.A.R.E.S. applies the underlying autonomy principle more broadly: participation should not automatically be treated as the preferred outcome simply because an opportunity has been made available.

Depending on the context, participation, modified participation, postponement or non-participation may each represent an autonomous decision.

6. WHO standards and informed choice

World Health Organization standards for maternal and newborn healthcare provide further institutional support for informed choice and decision-making.

WHO standards address informing women about their rights and care options, supporting women in decision-making, respecting personal values and beliefs, and obtaining consent before relevant procedures.

These principles support the inclusion of information, options, consent and decision-making within the Choice and Autonomy domains of C.A.R.E.S.

7. Autonomy can exist within relationships

Autonomy does not require a woman to make decisions in isolation.

Shared decision-making literature recognises that decisions may occur within wider interpersonal and social contexts. Advice from professionals, discussion with partners or family, and consideration of other people's views do not automatically remove autonomy.

The relevant distinction is whether those influences assist decision-making or become coercive, manipulative or otherwise prevent a voluntary decision.

This supports the C.A.R.E.S. position that Autonomy should not be confused with isolation or independence from all external influence.

8. Organisational barriers can affect autonomy

Autonomy may also be affected by institutional or environmental conditions rather than solely by interpersonal pressure.

Contemporary person-centred healthcare guidance recognises that limited options, policies and systemic barriers can affect people's practical ability to exercise autonomy.

This is particularly relevant to C.A.R.E.S. because the framework evaluates the conditions surrounding participation rather than assuming that an available theoretical choice is necessarily usable in practice.

Références

How this evidence supports C.A.R.E.S.

Collectively, these sources support several principles incorporated into the framework:

• decision-making should remain with the individual where she has the capacity to decide;
• meaningful decisions require relevant and understandable information;
• alternatives are relevant to meaningful choice;
• refusal can be a legitimate outcome;
• voluntary decisions should be distinguished from coercion or undue pressure;
• formal consent alone does not necessarily establish meaningful autonomy;
• social and institutional conditions can influence practical decision-making.

Evidence Base · Respect

Respect is a distinct domain of the NRE C.A.R.E.S. Framework™ because practical participation involves more than access and individual decision-making.

Dignity, privacy, consent, interpersonal behaviour and freedom from harassment or mistreatment can materially affect the conditions under which women participate in workplaces, healthcare, recreation, public environments and other activities.

The evidence presented here supports concepts incorporated within the Respect domain. It does not constitute independent validation of the complete C.A.R.E.S. methodology.

1. Dignity as a component of respectful environments

World Health Organization standards provide established examples of dignity being treated as an essential component of respectful care.

WHO describes respectful care as care organised and provided in a manner that maintains dignity, protects privacy and confidentiality, respects rights, supports informed choice and protects people from harm and mistreatment.

Although these standards arise from healthcare, they provide evidence for the broader C.A.R.E.S. distinction between technical access to a service and the interpersonal conditions under which participation occurs.

2. Privacy and confidentiality

WHO quality-of-care standards explicitly address privacy and confidentiality and recognise that the physical environment can either support or undermine them.

The standards identify practical measures such as appropriate physical arrangements, procedures protecting confidentiality and mechanisms for addressing violations of privacy, confidentiality or consent.

This provides evidence for the interaction between the C.A.R.E.S. Respect and Environment domains.

Privacy may depend not only on individual behaviour but also on the design, rules and management of the environment itself.

3. Consent and respectful participation

WHO standards for respectful care recognise permission and informed choice as important components of women's healthcare experiences.

Research supported by WHO has also documented medical examinations and procedures being performed without women's consent, demonstrating why formal access to a service cannot automatically be equated with respectful participation.

C.A.R.E.S. applies the underlying principle carefully: where an interaction requires consent, participation in the broader environment should not automatically be interpreted as consent to every subsequent interaction.

4. Mistreatment can undermine participation

WHO research into women's experiences during childbirth has identified forms of mistreatment including physical and verbal abuse, stigma, discrimination, poor interpersonal relationships and failures to meet professional standards.

WHO has consequently emphasised that quality involves both the provision of services and people's experience of those services.

This distinction supports the C.A.R.E.S. principle that the existence of facilities, policies or opportunities alone does not establish respectful conditions.

5. Violence and harassment in the workplace

The International Labour Organization's Violence and Harassment Convention, 2019 (No. 190) recognises the right of everyone to a world of work free from violence and harassment, including gender-based violence and harassment.

The Convention and associated ILO guidance provide an important institutional foundation for considering violence and harassment as workplace conditions rather than merely private interpersonal matters.

This is relevant to the C.A.R.E.S. Respect, Environment and Safety domains when the framework is applied to employment.

6. Women and workplace harassment

ILO reporting indicates that violence and harassment can affect workers across occupations and sectors, while women are particularly exposed to some forms, including sexual violence and harassment.

The ILO also recognises that barriers may discourage people from reporting their experiences.

This supports the C.A.R.E.S. decision to examine not only whether rules prohibit inappropriate behaviour, but also whether reporting mechanisms and organisational responses operate effectively in practice.

7. Policies alone are not sufficient

ILO guidance for employers addresses prevention and management of violence and harassment through organisational policies, risk management, implementation measures and responses to incidents.

This reinforces an important C.A.R.E.S. methodological principle: a written policy is evidence of a formal organisational position, but should not automatically be treated as proof that the policy is consistently implemented.

Where sufficient information is available, an assessment may therefore distinguish between:

• the existence of a policy;
• whether participants know about it;
• whether reporting mechanisms are accessible;
• whether complaints are appropriately considered;
• whether identified problems result in appropriate action.

8. Respect and freedom from objectification

C.A.R.E.S. includes unwanted sexualisation and objectifying behaviour within the Respect domain where they are relevant to the environment being assessed.

This is particularly important in settings involving bodies, changing, swimming, healthcare, sport, wellness or non-sexual nudity.

A woman's presence, appearance, clothing or participation in an activity should not itself be treated as consent to sexual attention.

Where claims concerning objectification or sexualisation are made in a formal assessment, they should be supported by evidence appropriate to the particular context rather than assumed solely because women are present.

9. Respect requires mechanisms for redress

WHO quality standards include accountability mechanisms for violations of privacy, confidentiality and consent. ILO guidance similarly addresses organisational prevention, response and redress in relation to workplace violence and harassment.

These sources support the inclusion of complaint and reporting mechanisms within C.A.R.E.S. where such mechanisms are appropriate to the environment being assessed.

The existence of a reporting mechanism does not guarantee a respectful environment, but its absence or ineffectiveness may represent a relevant organisational constraint.

Références

How this evidence supports C.A.R.E.S.

Collectively, these sources support several principles incorporated into the Respect domain:

• dignity is relevant to the quality of participation;
• privacy and confidentiality can require both behavioural and environmental protections;
• consent should be respected where consent is required;
• participation does not imply consent to unrelated interactions;
• violence, harassment and mistreatment can materially affect participation;
• organisations can have responsibilities for prevention and response;
• written policies should be distinguished from their implementation in practice;
• accessible reporting and redress mechanisms can form part of a respectful organisational environment.

Evidence Base · Environment & Safety

The Environment and Safety domains of the NRE C.A.R.E.S. Framework™ recognise that women's practical use of an environment may be influenced by physical design, social conditions, transport, time of day, organisational arrangements and reasonably foreseeable hazards.

The evidence presented here supports concepts incorporated within these domains. It does not establish independent validation of the complete C.A.R.E.S. Framework™.

1. Safety is shaped by multiple interacting conditions

A 2025 systematic literature review by te Braak and van Tienoven examined research concerning women's perceived safety in urban public spaces.

The review organised relevant influences across individual, social, environmental and temporal factors. It also highlighted variation among women rather than treating women as a homogeneous population.

This directly supports the C.A.R.E.S. decision to examine an environment through multiple interacting dimensions and to include time as a distinct consideration.

2. Built environment conditions can influence perceived safety

Dubey, Bailey and Lee's 2025 review of women's perceived safety in public places and public transport identified the significance of built environment characteristics alongside individual and social factors.

The review highlighted factors associated with the physical environment, including street lighting and walking conditions, while also identifying social cohesion and community trust as relevant to perceived safety.

This supports the C.A.R.E.S. approach of considering both physical and social conditions rather than treating infrastructure alone as sufficient.

3. Time matters

The systematic review by te Braak and van Tienoven identified temporal factors as part of women's safety perceptions and noted that existing research has often reduced time primarily to a day-versus-night distinction.

C.A.R.E.S. therefore recognises time more broadly. Relevant temporal conditions may include:

• daytime and nighttime conditions;
• staffing at different hours;
• public transport frequency;
• opening and closing times;
• changes in pedestrian activity;
• periods of isolation or crowding;
• shift arrangements;
• seasonal daylight and weather conditions.

The same physical location may therefore warrant different C.A.R.E.S. conclusions under materially different temporal conditions.

4. Public-space safety and autonomous mobility

UN Women's Safe Cities and Safe Public Spaces for Women and Girls initiative explicitly connects women's safety in public spaces with women's ability to use those spaces and move through cities autonomously.

Its work includes local data collection, laws and policies, urban and transport planning, social-norm interventions and measures addressing sexual harassment and other forms of violence against women and girls in public spaces.

Recent UN Women reporting continues to identify three related objectives: reducing sexual harassment, increasing women's feelings of safety and increasing women's autonomous mobility.

5. Transport forms part of environmental access

Public-space research and UN Women programmes both recognise transport as relevant to women's access to urban environments.

This supports the inclusion of transport within C.A.R.E.S. where it materially affects participation.

A destination may itself provide supportive conditions while the journey required to reach or leave it creates practical constraints, particularly during early-morning or late-night periods.

Relevant assessment considerations may therefore include:

• availability of public transport;
• location of stops or parking;
• lighting of access routes;
• waiting conditions;
• connections between transport and the destination;
• availability of transport when an activity finishes.

6. Occupational environments require hazard identification

World Health Organization occupational-health guidance identifies a broad range of workplace hazards, including physical hazards, psychosocial risks, occupational injuries, environmental hazards, violence and harassment.

WHO identifies working time and shift work among factors relevant to occupational stress and fatigue and recognises slips, falls, road traffic injuries and other physical hazards within occupational environments.

This evidence supports the C.A.R.E.S. Safety principle that assessments should identify hazards relevant to the particular environment rather than relying on a generic concept of safety.

7. Organisational conditions can modify risk

WHO guidance concerning workplace violence and harassment recommends identifying risks, improving work organisation and considering factors such as staffing, working time, lone work, lighting, security arrangements and access to assistance.

WHO also recommends reporting, recording and monitoring incidents and maintaining confidential complaint or grievance procedures.

This supports the C.A.R.E.S. position that Safety is not determined solely by the physical environment. Organisational practices can either reduce or intensify relevant risks.

8. Lighting and visibility are contextual safety factors

Lighting repeatedly appears within research and institutional guidance as a relevant feature of environmental and personal-safety conditions.

C.A.R.E.S. does not treat lighting as a universal proxy for safety. Instead, lighting should be considered alongside route design, visibility, activity levels, transport, staffing and other relevant conditions.

A brightly illuminated environment should therefore not automatically receive a favourable Safety classification if other material risks remain.

9. Perceived safety and documented risk should be distinguished

Research concerning women's public-space use frequently examines perceived safety. This provides important information about whether women feel able or willing to use particular environments.

Perceived safety, however, is not identical to documented crime rates, recorded incidents or independently assessed physical hazards.

C.A.R.E.S. therefore requires assessors to identify which type of evidence supports a conclusion.

10. Absence of recorded incidents does not prove absence of risk

Incident statistics can provide useful evidence but require careful interpretation.

Not every incident is necessarily reported or recorded, and an absence of recorded incidents does not establish that an environment is risk-free. Conversely, the occurrence of an incident does not by itself establish that every person using the environment faces the same level of risk.

C.A.R.E.S. therefore uses multiple forms of evidence where practicable and avoids treating any single indicator as a complete measure of Safety.

11. Safety measures should be proportionate

Risk management can sometimes create tension with Choice and Autonomy.

C.A.R.E.S. therefore requires safety concerns to be identified without automatically assuming that restricting women's participation is the appropriate response.

Where reasonably practicable, priority should be given to improving the conditions producing the risk, such as infrastructure, staffing, transport, procedures or access to assistance.

Restrictions may still be necessary in some circumstances, particularly where law, professional obligations or significant hazards require them, but those restrictions should not be based simply on assumptions that women are inherently vulnerable.

12. Environment and Safety remain separate domains

Evidence also supports keeping Environment and Safety analytically distinct.

Environment describes the physical, social, organisational and temporal conditions surrounding participation.

Safety asks whether relevant hazards and personal-safety concerns within those conditions have been identified and appropriately addressed.

The two domains therefore interact, but they answer different questions.

Références

How this evidence supports C.A.R.E.S.

Collectively, these sources support several principles incorporated into the Environment and Safety domains:

• physical design is only one component of environmental usability;
• social and temporal conditions can influence women's experiences of public spaces;
• public-space safety can affect autonomous mobility;
• transport may determine whether an otherwise available opportunity is practically accessible;
• workplace hazards can include physical, psychosocial and interpersonal risks;
• staffing, working time, lone work and organisational procedures may influence risk;
• lighting and visibility are relevant but should not be used as stand-alone measures of safety;
• perceived safety and documented hazards should be identified as different forms of evidence;
• safety interventions should address identified conditions without unnecessarily restricting agency.

Evidence Base · Diversity, Accessibility & Intersectionality

The NRE C.A.R.E.S. Framework™ does not assume that all women experience the same environment in the same way.

Women's practical access, experiences, preferences and constraints may differ according to multiple interacting circumstances. These may include age, disability, mobility, caring responsibilities, socioeconomic circumstances, cultural context, location, transport access and other factors relevant to the particular environment being assessed.

The evidence presented here supports the framework's decision to recognise variation among women rather than construct a single hypothetical “average woman.”

1. Women's experiences of environments are not uniform

The 2025 systematic review by te Braak and van Tienoven identified substantial complexity in research concerning women's perceived safety in urban public space.

The review specifically highlighted the importance of intersectionality and identified a need for research that better accounts for differences among women rather than treating gender as an isolated characteristic.

This supports the C.A.R.E.S. principle that conclusions should not be automatically generalised from one group of women to all women.

2. Intersectionality

The concept of intersectionality was developed by legal scholar Kimberlé Crenshaw to describe how forms of disadvantage cannot always be understood adequately when categories such as race and gender are considered separately.

Intersectional approaches have subsequently become influential across public health, gender research and social policy.

For C.A.R.E.S., the practical implication is methodological rather than ideological: an assessment should remain alert to interacting conditions that may produce different experiences within the population described as women.

C.A.R.E.S. should not assume that gender alone explains every difference identified in participation or environmental use.

3. Disability and environmental accessibility

The World Health Organization recognises that disability results from the interaction between health conditions and personal and environmental factors.

WHO also identifies inaccessible transportation, public buildings, information and other environmental barriers as factors capable of restricting participation.

This provides a strong foundation for the C.A.R.E.S. Environment domain: physical availability does not necessarily establish practical accessibility.

4. Accessibility involves more than physical entry

The United Nations Convention on the Rights of Persons with Disabilities recognises accessibility across the physical environment, transportation, information and communications, and facilities and services open or provided to the public.

This broader understanding is consistent with C.A.R.E.S., which does not reduce accessibility to whether a person can physically cross an entrance.

Depending on the context, practical accessibility may involve:

• routes through an environment;
• transport;
• toilets and facilities;
• communication and information;
• signage;
• physical design;
• availability of assistance;
• operating arrangements.

5. Age and life stage

Women's environmental needs and practical constraints may change across the life course.

Factors such as mobility, work, pregnancy, caring responsibilities and ageing may alter which environmental conditions become relevant to participation.

C.A.R.E.S. therefore permits life-stage considerations where they are relevant to the defined assessment, while avoiding the assumption that age alone determines an individual's needs or preferences.

6. Caring responsibilities and practical access

International Labour Organization research documents the substantial amount of unpaid care work undertaken globally and persistent gender inequalities in the distribution of care responsibilities.

Caring responsibilities can affect time availability, work participation and practical access to services or activities.

Within C.A.R.E.S., caring responsibilities may therefore be relevant when assessing operating hours, scheduling, transport, facilities or other conditions affecting realistic participation.

The framework should not assume that every woman is a caregiver or that caring is inherently a woman's responsibility.

7. Geography and transport

Environmental opportunity can also vary substantially according to geography.

Women living in urban, suburban, regional, rural or remote environments may encounter different transport networks, service availability, distances, infrastructure and operating conditions.

C.A.R.E.S. assessments should therefore avoid treating conclusions from one geographic setting as automatically transferable to another.

8. Culture and social context

Social expectations, privacy norms, family circumstances and community conditions can influence how environments and activities are experienced.

C.A.R.E.S. may consider cultural or social context where relevant, but should avoid assuming that membership of a cultural, religious, national or other group determines an individual woman's preferences or behaviour.

Evidence concerning groups should be used to understand possible conditions and barriers, not to assign characteristics automatically to individuals.

9. Previous experiences

Previous experiences may influence how people perceive and use environments.

A woman who has experienced harassment or another adverse event in a location may evaluate subsequent participation differently from someone without that experience.

C.A.R.E.S. can recognise reported experiences as relevant evidence while avoiding assumptions about how any particular experience must affect future behaviour.

10. Avoiding stereotypes

Recognising variation does not justify replacing one generalisation with another.

C.A.R.E.S. should not assume, for example, that:

• older women are necessarily less independent;
• women with disabilities necessarily require assistance;
• mothers have identical participation preferences;
• women from a particular culture share identical boundaries;
• younger women necessarily feel more or less safe;
• previous adverse experiences determine future choices.

Relevant characteristics should inform analysis only where there is a defensible reason for including them.

11. Implications for C.A.R.E.S. assessments

Where relevant evidence permits, assessors should identify:

• which women were represented in the evidence;
• which groups may have been underrepresented;
• whether accessibility requirements materially alter practical use;
• whether time, transport or caring responsibilities create different barriers;
• whether findings from one population are being generalised beyond the evidence;
• whether apparently universal conclusions conceal important variation.

Références

How this evidence supports C.A.R.E.S.

Collectively, these sources support several principles incorporated into the framework:

• women should not be treated as a homogeneous population;
• multiple circumstances can interact to affect environmental participation;
• accessibility involves interaction between people and environmental barriers;
• physical availability does not necessarily establish practical accessibility;
• transport, caring responsibilities and geography may affect realistic access;
• population patterns should not be converted into assumptions about individuals;
• assessments should identify the population and circumstances represented by their evidence.

Evidence Synthesis · What the Evidence Supports and What Remains to Be Tested

The evidence reviewed for the NRE C.A.R.E.S. Framework™ supports the relevance of its underlying concepts across several established fields of research and professional practice.

Evidence concerning autonomy, informed decision-making, dignity, privacy, harassment, accessibility, public-space use, perceived safety, environmental conditions and occupational safety provides a defensible foundation for examining the conditions surrounding women's participation.

This evidence does not establish that the complete five-domain C.A.R.E.S. methodology has been independently validated.

1. What the evidence supports

The evidence reviewed provides support for several propositions underlying the framework.

• Meaningful participation involves more than simply making an activity technically available.
• Information and realistic alternatives can be relevant to meaningful choice.
• Voluntariness and freedom from inappropriate pressure are relevant to autonomy.
• Dignity, privacy, consent and freedom from mistreatment are relevant to respectful participation.
• Physical design can influence environmental usability.
• Social and organisational conditions can affect practical participation.
• Time of day and transport conditions can materially alter access to the same environment.
• Perceived safety can influence women's use of public environments.
• Workplace safety involves physical, psychosocial, organisational and interpersonal considerations.
• Accessibility involves interaction between individuals and environmental barriers.
• Women should not be treated as a homogeneous population.

2. What the evidence does not yet establish

Existing research supporting individual concepts should not be interpreted as evidence for claims that have not yet been tested.

At its current stage of development, the evidence does not establish that:

• the five C.A.R.E.S. domains represent the only appropriate domains;
• the domains have optimal boundaries;
• each domain should receive equal analytical importance;
• the four assessment classifications have established reliability;
• different assessors will consistently reach the same classification;
• C.A.R.E.S. predicts women's participation decisions;
• C.A.R.E.S. predicts health or wellbeing outcomes;
• a Supportive classification predicts absence of adverse events;
• the framework is suitable without modification for every cultural or geographic context;
• the framework has been independently validated.

3. C.A.R.E.S. is not designed to predict women's behaviour

C.A.R.E.S. evaluates conditions rather than attempting to predict whether an individual woman will participate.

A woman may decline an activity in an environment assessed as Supportive. Another may choose to participate in an environment containing significant constraints.

Neither decision automatically invalidates the assessment.

Individual decision-making can involve circumstances and preferences that fall outside the scope of an environmental framework.

4. Research question · Are the five domains sufficiently distinct?

Choice, Autonomy, Respect, Environment and Safety have deliberately been defined separately.

Some interaction between them is unavoidable. For example, poor environmental conditions may affect Safety, inappropriate organisational pressure may affect both Choice and Autonomy, and privacy arrangements may involve both Respect and Environment.

Future testing should examine whether users of the framework can distinguish these domains consistently and whether any boundaries require refinement.

5. Research question · Can different assessors reproduce results?

A formal assessment methodology becomes more useful when different appropriately informed assessors examining substantially the same evidence can reach reasonably consistent conclusions.

Future C.A.R.E.S. research should therefore examine inter-rater consistency.

If assessors repeatedly classify the same conditions differently, the framework may require clearer definitions, decision rules or evidence requirements.

6. Research question · Are the classifications sufficiently clear?

C.A.R.E.S. currently uses four classifications:

• Supportive;
• Partially supportive;
• Constrained;
• Insufficient information.

Pilot testing should examine whether these categories can be applied consistently and whether assessors can distinguish, for example, Partially supportive from Constrained without excessive subjective interpretation.

7. Research question · Does the framework identify useful improvements?

C.A.R.E.S. is intended not merely to describe environments but also to identify conditions that may reasonably be improved.

Pilot studies should therefore examine whether assessments generate specific and actionable findings rather than broad or obvious conclusions.

Potential improvements might involve facilities, information, transport, operating times, privacy arrangements, reporting procedures, staffing or other conditions identified through the assessment.

8. Research question · Does C.A.R.E.S. work across different settings?

The framework is intentionally designed for application beyond naturism.

Its usefulness should therefore be tested across substantially different environments, potentially including:

• urban parks;
• workplaces;
• night-work environments;
• transport settings;
• sport and recreation facilities;
• healthcare environments;
• community activities;
• naturist environments.

If substantial modifications are required for particular settings, those adaptations should be documented rather than concealed.

9. Research question · How well does C.A.R.E.S. represent different women?

Future research should deliberately examine whether the framework adequately identifies conditions relevant to women with different circumstances.

This may include variation associated with disability, age, caring responsibilities, geographic location, transport availability, socioeconomic circumstances and other relevant factors.

The purpose should not be to create fixed categories of women, but to test whether the framework is sufficiently flexible to recognise meaningful differences in environmental access and participation.

10. Research question · Should C.A.R.E.S. ever become numerical?

The current framework deliberately avoids an aggregate numerical score.

Future research may examine whether quantitative measures could add useful information, but numerical scoring should only be introduced if there is a defensible basis for:

• item selection;
• measurement scales;
• weighting;
• reliability;
• interpretation;
• thresholds;
• appropriate comparison between environments.

Until such evidence exists, numerical scoring could create false precision and should not form part of the official framework.

11. Proposed research pathway

A responsible development pathway for C.A.R.E.S. may include:

• continued structured literature review;
• expert and stakeholder review;
• consultation with diverse groups of women;
• development of assessor guidance;
• pilot assessments across different environments;
• inter-rater consistency testing;
• analysis of recurring ambiguities;
• revision of domain definitions where evidence requires it;
• independent academic or professional review;
• publication of methodological revisions.

12. Evidence-informed does not mean evidence-finished

Describing C.A.R.E.S. as evidence-informed reflects that its underlying concepts are grounded in relevant research, institutional standards and established areas of professional practice.

It should not imply that research into the framework is complete.

C.A.R.E.S. should remain open to revision where credible evidence identifies weaknesses, omissions or better methods.

13. Research integrity commitment

NRE Health Institute should maintain a clear distinction between:

• evidence supporting an underlying concept;
• evidence supporting a particular C.A.R.E.S. domain;
• evidence generated through practical application of the framework;
• independent evaluation of the methodology;
• formal validation, if such validation is undertaken in the future.

Findings that challenge the framework should be considered alongside findings that support it.

Material changes resulting from future research should be documented through version control.

Publication & Version Record

Recommended citation

Version control

Version 1.0 establishes the original published methodology of the NRE C.A.R.E.S. Framework™.

Future material changes to domain definitions, assessment methodology, classifications or interpretation should be issued under a new version number and publication date.

Previous versions should remain identifiable so that assessments can be traced to the methodology in effect when they were conducted.

Use of the framework

When C.A.R.E.S. is referenced or applied by another party, the framework name and version should be identified where reasonably practicable.

Use of the framework does not imply endorsement, certification, accreditation or approval by NRE Health Institute.

Modified methodologies should not be represented as the official NRE C.A.R.E.S. Framework™ unless those modifications have been formally adopted by NRE Health Institute.