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Kearns S, Hardie P, O’Shea D, Neff K. Instruments used to assess gender-affirming healthcare access: A scoping review. PLoS One 2024; 19:e0298821. [PMID: 38829881 PMCID: PMC11146745 DOI: 10.1371/journal.pone.0298821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/30/2024] [Indexed: 06/05/2024] Open
Abstract
PURPOSE The overall aim of this scoping review was to identify, explore and map the existing literature pertaining to healthcare access for transgender and non-binary individuals. DESIGN The scoping review followed Arksey and O'Malley's methodological framework, and the reporting adhered to the guidelines provided by the PRISMA Extension for Scoping Reviews. METHODS To gather relevant articles, a comprehensive search strategy was employed across four electronic databases, with the assistance of a university librarian. In addition, manual and internet searches were conducted for grey literature. From the initial search, a pool of 2,452 potentially relevant articles was retrieved, which was supplemented by an additional 23 articles from the supplemental search. After an independent review by two researchers, 93 articles were assessed, resulting in the inclusion of 41 articles in the review. RESULTS The literature highlights the identification of barriers and enablers, spanning across 32 individual data sets that affect healthcare accessibility for transgender and non-binary individuals. Leveque's five dimensions of healthcare access, namely approachability, acceptability, availability and accommodation, affordability, and appropriateness, were utilized to categorise these 42 factors. Some of the key themes that emerged in these dimensions include challenges in accessing information about services, concerns about acceptance from family and peers, past experiences of discrimination in healthcare settings, considerations related to cost and insurance, and the difficulty in finding appropriately trained competent providers. CONCLUSIONS The review focused on the most commonly researched aspects of healthcare access and identified gaps in research and opportunities for future studies. The findings provide recommendations for policy and practice, which could guide the development of interventions aimed at addressing the barriers faced by transgender individuals seeking gender-affirming care.
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Affiliation(s)
- Seán Kearns
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
| | - Philip Hardie
- Nursing Programme, Hibernia College, Dublin, Ireland
| | - Donal O’Shea
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
| | - Karl Neff
- School of Medicine, University College Dublin, Dublin, Ireland
- St Columcille’s Hospital, Dublin, Ireland
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Thomas SD, King R, Murphy M, Dempsey M. Demographic factors associated with healthcare avoidance and delay in the transgender population: Findings from a systematic review. DIALOGUES IN HEALTH 2023; 3:100159. [PMID: 38515802 PMCID: PMC10954025 DOI: 10.1016/j.dialog.2023.100159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/02/2023] [Accepted: 11/09/2023] [Indexed: 03/23/2024]
Abstract
Purpose Healthcare avoidance and delay (HAD) in the transgender population has been well documented, and research has explored a range of associated factors that help to identify those most at risk of HAD. This review addresses a gap in the research by synthesizing research exploring associations between HAD and demographic factors. Methods A systematic search of literature published at any time up to December 2021 was conducted, using five databases (EBSCO, EMBASE, PubMed, Scopus, and Web of Science) and manually searching reference lists of included studies. After exclusion of duplicates, 608 unique records were subjected to double screening. Papers reporting statistical analyses of HAD in association with any sociodemographic variables were included in this review. Papers consisted of nineteen cross-sectional studies. Narrative synthesis was used to address findings. Results Nineteen studies met inclusion criteria, exploring HAD in association with a wide range of demographic factors, including sex and gender, social transition factors, age, race and ethnicity, socioeconomic factors, veteran status, education, sexuality, relationship status, citizenship, place of residence, and state demographics. Findings identified intra-community demographic risk factors, with consistent evidence for increased HAD among transmasculine, and younger, participants. Lower income and higher educational attainment were also associated with increased HAD, while remaining areas had weak or little evidence for association with HAD. Conclusion This review expands knowledge in this area by highlighting demographic factors associated with increased HAD in research literature, and exploring how these may be further investigated to address substantial gaps in the body of research.
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Affiliation(s)
- Siobhan D. Thomas
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Robert King
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
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Kim R, Choo S, Lee H, Eom YJ, Yi H, Kim R, Kim SS. Does discrimination prevent transgender and gender diverse people from seeking healthcare?: A nationwide cohort study in South Korea. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:283-294. [PMID: 38681498 PMCID: PMC11044721 DOI: 10.1080/26895269.2023.2215750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Introduction Using Asia's first nationwide cohort dataset, this study aimed to assess the prevalence of anti-transgender discrimination and healthcare avoidance and delay (HAD) and examine their associations among transgender and gender diverse (TGD) adults in South Korea. Methods We analyzed a two-wave (2020-2021) longitudinal dataset of 190 Korean TGD adults. Anti-transgender discrimination were classified accordingly: experienced at (1) neither wave, (2) baseline (2020) only, (3) follow-up (2021) only, and (4) both waves. We also asked about HAD in the past 12 months at follow-up for both transition-related and non-transition-related healthcare services. Multivariate modified Poisson regression was used to examine the associations between anti-transgender discrimination and HAD. Results Of 190 participants, 102 (53.7%) experienced anti-transgender discrimination at both waves, and 130 (68.4%) reported HAD at follow-up. Compared to those without any experiences of anti-transgender discrimination, those who experienced it in both waves had a 1.78-times (95% CI: 1.21-2.63) higher prevalence of non-transition-related HAD, but not among those who experienced it in either wave. In contrast, anti-transgender discrimination was not associated with transition-related HAD. Conclusion In order to enhance healthcare access for transgender and gender diverse (TGD) individuals, it is necessary to implement interventions, such as anti-discrimination laws, that protect them from discrimination.
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Affiliation(s)
- Ranyeong Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Sungsub Choo
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hyemin Lee
- Healthcare Policy Team, Jeju Institute of Public Health & Health Policy, Jeju, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Horim Yi
- Solidarity for LGBT Human Rights of Korea, Seoul, Republic of Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Wang YC, Miao NF, You MH, Wang FTY, Hsu CY, Lee PH, Du SC. Enhancing cultural competence in caring for lesbian, gay, bisexual, and transgender patients: An online training program for Taiwanese student nurses and nurses. NURSE EDUCATION TODAY 2023; 129:105914. [PMID: 37481921 DOI: 10.1016/j.nedt.2023.105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Health disparities exist among lesbian, gay, bisexual, and transgender (LGBT) populations worldwide. However, student nurses and nurse staff have limited knowledge and skills in providing culturally competent nursing care for LGBT patients in Taiwan. OBJECTIVES This paper describes the development, implementation, and evaluation of an online training program for the cultural competence of student nurses and nurses in Taiwan. DESIGN A one-group pre-/post-test study design. SETTINGS The study was conducted in five nursing schools, 10 nursing associations, and 37 long-term care facilities. Two prominent online bulletin boards (PTT Nurse and Dcard Nurse) and one Taiwanese nursing group on Facebook were used to recruit participants. PARTICIPANTS In total, 301 student nurses and nurses participated in the study and responded to pre- and post-test questionnaires. METHODS An online training program for culturally competent nursing care was developed and implemented. The pre- and post-test questionnaires contained three sections: (1) demographics, (2) knowledge of LGBT health, and (3) the Sexual Orientation Counselor Competency Scale. Three open-ended questions were included in the post-test questionnaire to evaluate the online training program. RESULTS The online training program significantly improved the participants' knowledge and cultural competence skills. However, their attitudes towards cultural competence did not change after the program was implemented. Regarding qualitative feedback of the online training program, feedback on the strengths and limitations of the program was summarized under three themes: program content, website design, and online modules. CONCLUSIONS The results suggest the importance of an online training program which may contribute to reducing health disparities among the LGBT population.
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Affiliation(s)
- Ya-Ching Wang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Nae-Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Mei-Hui You
- Graduate Institute of Gender Education, National Kaohsiung Normal University, Taiwan.
| | - Frank T Y Wang
- Graduate Institute of Social Work, National Chengchi University, Taipei, Taiwan.
| | | | - Po-Han Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Sih-Cheng Du
- Taiwan Tongzhi (LGBTQ+) Hotline Association, Taiwan.
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Eom YJ, Lee H, Kim R, Choo S, Yi H, Kim SS. Discrimination keeps transgender people awake at night: A nationwide cross-sectional survey of 583 transgender adults in South Korea. Sleep Health 2022; 8:580-586. [PMID: 36050274 DOI: 10.1016/j.sleh.2022.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We sought to investigate the association between transgender identity discrimination and sleep problems among transgender people in South Korea (hereafter, Korea), and whether family support for transgender identity plays a protective role in the association. DESIGN & SETTING We analyzed a nationwide cross-sectional survey of 583 Korean transgender adults which was anonymously conducted through an online platform. MEASUREMENTS Transgender identity discrimination was assessed using a single-item question. Sleep problems were defined as having any of the following problems: poor sleep quality, short sleep duration, and use of alcohol or sleep medications to fall asleep. Family support for transgender identity was classified into 3 groups as follows: not supportive, supportive, and unaware of participants' transgender identity. RESULTS Of 583 participants, 383 (65.7%) experienced transgender identity discrimination over the past 12 months. Participants who experienced transgender identity discrimination were 1.48 times (95% confidence intervals [95% CI] = 1.19-1.83) more likely to have any sleep problems, compared to those who never experienced transgender identity discrimination. When stratified by family support level, the associations between transgender identity discrimination and sleep problems remained statistically significant only among those with a family unsupportive (adjusted prevalence ratio [aPR] = 1.64; 95% CI = 1.16-2.31) or unaware (aPR = 1.60; 95% CI = 1.01-2.52) of participants' transgender identity. However, the association was not statistically significant among those with a supportive family (aPR = 1.41; 95% CI = 0.96-2.07). CONCLUSION Given transphobic environments in Korea, legal and institutional efforts are required to reduce transgender identity discrimination (eg, anti-discrimination laws) as well as to build trans-specific family resources.
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Affiliation(s)
- Yun-Jung Eom
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Hyemin Lee
- Jeju Institute of Public Health & Health Policy, Jeju, South Korea
| | - Ranyeong Kim
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Sungsub Choo
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Horim Yi
- Solidarity for LGBT Human Rights of Korea, Seoul, South Korea
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Maryland, USA.
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Wang YC, Miao NF, You MH. Attitudes toward, knowledge of, and beliefs regarding providing care to LGBT patients among student nurses, nurses, and nursing educators: A cross-sectional survey. NURSE EDUCATION TODAY 2022; 116:105472. [PMID: 35834866 DOI: 10.1016/j.nedt.2022.105472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/12/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Studies have assessed attitudes toward, knowledge of, and beliefs regarding providing care for lesbian, gay, bisexual, and transgender (LGBT) patients among student nurses, nurses, and nursing educators individually, but few studies have compared these aspects among these groups. OBJECTIVES To examine the attitudes toward, knowledge of, and beliefs regarding providing care for LGBT patients among student nurses, nurses, and nursing educators in Taiwan. DESIGN Cross-sectional survey. SETTINGS The study was advertised in 8 nursing schools, 14 nursing associations, 209 nursing homes, and 2 online chatrooms in Taiwan. PARTICIPANTS A total of 1150 participants were recruited: 447 student nurses, 475 nurses, and 228 nursing educators. METHODS Data were collected between August 2021 and January 2022 through a questionnaire with five sections: demographics, knowledge of LGBT health, the Knowledge about Homosexuality Questionnaire, the Attitude Toward Lesbian and Gay Men Scale, and the Gay Affirmative Practice Scale. RESULTS The results suggest that the participants had limited knowledge of LGBT health. The nursing educators had the lowest scores for knowledge of LGBT health and homosexuality and the most negative attitudes toward lesbians and gay men among the groups; however, they were most likely to report their beliefs regarding providing nursing care to LGBT patients than the other two groups. CONCLUSIONS The results indicate the importance of providing nursing educators with training courses and resources related to culturally competent care to improve education for nursing students and care for LGBT patients.
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Affiliation(s)
- Ya-Ching Wang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Nae-Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Mei-Hui You
- Graduate Institute of Gender Education, National Kaohsiung Normal University, Taiwan.
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Choo S, Lee H, Yi H, Kim SS. Expectation of Rejection and Its Association with Health Care Avoidance and Delay Among 2175 Korean Lesbian, Gay, and Bisexual Adults: A Nationwide Cross-Sectional Survey. LGBT Health 2022; 9:282-286. [PMID: 35275735 DOI: 10.1089/lgbt.2021.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The study examined an association between expectation of rejection and health care avoidance and delay (HAD) among lesbian, gay, and bisexual (LGB) adults in South Korea. Methods: We analyzed data from a nationwide cross-sectional survey of 2175 South Korean LGB adults, which was approved by the Korea University Institutional Review Board. We categorized expectation of rejection into tertiles ("low," "medium," and "high" levels) and investigated its association with past 12-month HAD using multivariate modified Poisson regression. Results: After adjusting for covariates, including experiences of discrimination, participants with high levels of expectation of rejection had 1.38-times (95% confidence interval: 1.16-1.65) higher prevalence of HAD compared with those with low levels. Conclusion: Living in anticipation of rejection can negatively impact LGB adults' health care utilization.
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Affiliation(s)
- Sungsub Choo
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Hyemin Lee
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Horim Yi
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Lee H, Yi H, Rider GN, Operario D, Choo S, Kim R, Eom YJ, Kim SS. Transgender Adults' Public Bathroom-Related Stressors and Their Association with Depressive Symptoms: A Nationwide Cross-Sectional Study in South Korea. LGBT Health 2021; 8:486-493. [PMID: 34242110 DOI: 10.1089/lgbt.2021.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose: This study assessed public bathroom-related stressors and examined their association with depressive symptoms, suicidal ideation, and suicide attempts among transgender individuals in South Korea. Methods: We analyzed data from a nationwide cross-sectional survey of 557 South Korean transgender adults (age range: 19-60 years) conducted in October 2020. Participants were asked nine yes/no questions about whether they have ever experienced public bathroom-related stressors within the last 12 months. The responses were classified into three categories: "never experienced," "avoidant behaviors alone," and "victimization experiences." Results: The proportions of participants who reported "avoidant behaviors alone" and "victimization experiences" related to public bathroom use were 47.0% and 23.0%, respectively. Past-week prevalence of depressive symptoms was 70.7%, and past 12-month prevalence of suicidal ideation and suicide attempts was 63.0% and 19.8%, respectively. Compared with participants who "never experienced" public bathroom-related stressors, the prevalence of depressive symptoms was statistically significantly higher among those who reported "avoidant behaviors alone" (adjusted prevalence ratio [aPR] = 1.22; 95% confidence interval [CI] = 1.07-1.40) and "victimization experiences" (aPR = 1.18; 95% CI = 1.01-1.38), after adjusting for covariates, including gender perception by others. In the same adjusted model, however, no significant associations of public bathroom-related stressors with suicidal ideation and suicide attempts were observed. Conclusions: Given these findings showing that public bathroom-related stressors may negatively influence transgender adults' depressive symptoms, efforts are necessary to ensure their safe access to public bathrooms in South Korea. Furthermore, policy-level interventions are needed to eliminate stigma against transgender individuals, given that public bathroom-related stressors could be considered an indicator of broader anti-transgender stigma.
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Affiliation(s)
- Hyemin Lee
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Horim Yi
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - G Nic Rider
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sungsub Choo
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Ranyeong Kim
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Yun-Jung Eom
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Seung-Sup Kim
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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