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Brooks RA, Nieto O, Rosenberg-Carlson E, Morales K, Üsküp DK, Santillan M, Inzunza Z. Barriers and Facilitators to Accessing PrEP and Other Sexual Health Services Among Immigrant Latino Men Who Have Sex with Men in Los Angeles County. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02928-z. [PMID: 38977534 DOI: 10.1007/s10508-024-02928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024]
Abstract
In the United States, immigrant Latino men who have sex with men (ILMSM) are, compared to white MSM, disproportionately burdened by HIV and lack access to highly effective HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). Qualitative research centered on exploring barriers that ILMSM experience in accessing PrEP and other sexual services is extremely limited, despite a high prevalence of HIV in this population. In this study, a purposive sample of ILMSM (n = 25) was recruited to participate in a semi-structured in-depth interview to identify the distinct barriers and facilitators ILMSM experience in accessing sexual health services given their complex intersectional identities of being an immigrant, Latino, and a sexual minority man. Using a thematic analysis approach, nine themes were generated from the data representing barriers and facilitators. Barriers included: (1) cost and a lack of health insurance, (2) complexity of PrEP assistance programs; (3) challenges related to the immigrant experience; (4) impact of gay stigma; and (5) communication challenges. Facilitators included: (1) improving affordability and accessibility of PrEP services; (2) receiving services from LGBT- or Latine LGBT-centered clinics; (3) receiving services from medical providers who are gay and/or Latino; and (4) providing targeted community outreach, education, and promotion of PrEP to ILMSM. While many of the barriers illuminated in the study were structural (e.g., cost and lack of health insurance), and not easy to overcome, the findings highlight a range of facilitators that can support access to PrEP and other sexual health services for ILMSM. Considering these findings, we suggest strategies that may enhance access to needed sexual health services among ILMSM.
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Affiliation(s)
- Ronald A Brooks
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA.
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Research and Evaluation, Bienestar Human Services, Los Angeles, CA, USA.
| | - Omar Nieto
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA
| | - Elena Rosenberg-Carlson
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA
| | - Katherine Morales
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dilara K Üsküp
- Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- UCLA-CDU Center for AIDS Research, Los Angeles, CA, USA
| | - Martin Santillan
- Department of Research and Evaluation, Bienestar Human Services, Los Angeles, CA, USA
| | - Zurisadai Inzunza
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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Saunders RK, Carr DC, Burdette AM. Health Care Stereotype Threat and Sexual and Gender Minority Well-Being. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:20-37. [PMID: 37905532 DOI: 10.1177/00221465231205549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Sexual and gender minorities (SGMs) have experienced progressive change over the last 50 years. However, this group still reports worse health and health care experiences. An innovative survey instrument that applies stereotype threat to the health care setting, health care stereotype threat (HCST), offers a new avenue to examine these disparities. We harmonized two national probability data sets of SGMs-Generations and TransPop-capturing 503 gay men, 297 lesbians, 467 bisexuals, and 221 trans people. Using these data, we, first, explored how HCST's association with self-rated health and psychological distress changed while considering more established constructs: discrimination and stigma. Second, we examined how HCST's association varied across SGM groups. Results suggest that HCST is a unique predictor net of the associations with discrimination and stigma. Furthermore, results highlight the more consequential associations for trans people on well-being compared to gay men. We discuss implications of these findings for future research and potential interventions.
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Affiliation(s)
- R Kyle Saunders
- Knowli Data Science, Tallahassee, FL, USA
- Florida State University, Tallahassee, FL, USA
| | - Dawn C Carr
- Florida State University, Tallahassee, FL, USA
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Turpin R, Fish JN, King-Marshall E, Boekeloo B. Preliminary Psychometric Evaluation of Novel Measures of Therapist Practice Related to LGBTQ+ Clients. Healthcare (Basel) 2024; 12:110. [PMID: 38201015 PMCID: PMC10779343 DOI: 10.3390/healthcare12010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Culturally competent and equitable mental healthcare for LGBTQ+ people is critical for addressing mental health inequities for this population. Tools to assess therapists' practice with LGBTQ+ clients are needed for research and clinical efforts related to mental healthcare equity goals. METHODS We conducted a preliminary assessment of the reliability and validity of a novel 28-item self-report measure assessing therapist practice with LGBTQ+ clients. We examined the construct validity using factor analyses, the convergent and criterion validity using intercorrelations with LGBTQ-affirming knowledge, self-efficacy, and attitudes, and the internal consistency using Cronbach alpha. RESULTS Our overall total LGBTQ+ practice measure demonstrated excellent internal consistency (Cronbach's alpha = 0.91) and was strongly associated with LGBTQ+ knowledge (rho = 0.377), self-efficacy (rho = 0.633), and LGBTQ+ attitudes (rho = 0.305). We also identified two subscales: "Commitment to Continued Learning" and "Affirmative Practices", which demonstrated similarly strong internal consistency and tests of validity. CONCLUSIONS Our novel measure of overall LGBTQ+ practice, including two subscales, demonstrated strong reliability and validity. These findings have important implications for practice and research in mental healthcare for LGBTQ+ clients. Future research exploring these measures in relationship to mental healthcare outcomes is recommended.
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Affiliation(s)
- Rodman Turpin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA 22030, USA
- University of Maryland Prevention Research Center, College Park, MD 20742, USA; (J.N.F.); (E.K.-M.); (B.B.)
| | - Jessica N. Fish
- University of Maryland Prevention Research Center, College Park, MD 20742, USA; (J.N.F.); (E.K.-M.); (B.B.)
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Evelyn King-Marshall
- University of Maryland Prevention Research Center, College Park, MD 20742, USA; (J.N.F.); (E.K.-M.); (B.B.)
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Bradley Boekeloo
- University of Maryland Prevention Research Center, College Park, MD 20742, USA; (J.N.F.); (E.K.-M.); (B.B.)
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742, USA
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Hickey PM, Best LA, Speed D. Access to Healthcare and Unmet Needs in the Canadian Lesbian-Gay-Bisexual Population. JOURNAL OF HOMOSEXUALITY 2023:1-19. [PMID: 38019536 DOI: 10.1080/00918369.2023.2287034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Individuals who identify as a sexual minority, including those who are lesbian, gay, or bisexual (LGB), face barriers to healthcare as well as increased discrimination, stigmatization, and negative experiences during healthcare use. Further, few healthcare providers have education and training focused on the specific healthcare needs of individuals who are part of a sexual minority group. Given the limited research on Canadian healthcare access for sexual minorities, our purpose was to use data (n > 2,800) from the 2015-16 Canadian Community Health Survey (CCHS) to investigate the perceptions of healthcare access for LGB and non-LGB Canadians. Although non-LGB and LGB participants reported comparable access to a regular care provider and were equally likely to have consulted with a general practitioner in the past 12 months, LGB respondents were more likely to have seen a specialist and reported more unmet health needs. Although we expected the linear effects of both race and sex to vary by LGB status, this effect only occurred in one model. Current results have implications for addressing health inequalities for sexual minorities, including poorer health outcomes and greater discrimination.
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Affiliation(s)
- Patrick M Hickey
- Department of Psychology, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lisa A Best
- Department of Psychology, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - David Speed
- Department of Psychology, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
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Moore JX, Andrzejak SE, Casanova T, Langston ME, Estvold S, Adsul P. Investigating the Joint Effect of Allostatic Load among Lesbian, Gay, and Bisexual Adults with Risk of Cancer Mortality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6120. [PMID: 37372707 DOI: 10.3390/ijerph20126120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40-4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33-3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.
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Affiliation(s)
- Justin Xavier Moore
- Cancer Prevention, Control & Population Health Program, Department of Medicine, Augusta University, Augusta, GA 30912, USA
- Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Sydney Elizabeth Andrzejak
- Cancer Prevention, Control & Population Health Program, Department of Medicine, Augusta University, Augusta, GA 30912, USA
| | - Tracy Casanova
- Department of Psychiatry and Health Behavior, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA
| | - Marvin E Langston
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA 49305, USA
| | - Søren Estvold
- Department of Family Medicine, Augusta University, Augusta, GA 20912, USA
| | - Prajakta Adsul
- Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM 87131, USA
- Cancer Control and Population Sciences Research Program, Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM 87131, USA
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Joudeh L, Heavner SF, Johnstone E, Propst SK, Harris OO. Challenges and opportunities for medical referrals at a mobile community health clinic serving sexual and gender minorities in rural South Carolina: a qualitative approach. BMC Health Serv Res 2023; 23:168. [PMID: 36803696 PMCID: PMC9937739 DOI: 10.1186/s12913-023-09141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Sexual and gender minorities (SGM) in the Southern United States face challenges in accessing sexual and gender affirming health care. Alternative care models, like inclusive mobile clinics, help mitigate barriers to care for SGM. There is limited data in the literature on the experience of medical referral processes for SGM individuals accessing services from mobile health clinics. AIMS AND OBJECTIVES The purpose of this study is to describe the medical referral experiences of SGM clients and their providers at a mobile health clinic in the Southern United States. METHODS We recruited English-speaking individuals who provided care or received care from the mobile health clinic in South Carolina between June 2019 and August 2020. Participants completed a brief demographic survey and a virtual in-depth, semi-structured individual interview. Data analysis was conducted using an iterative process to generate codes, categories, and themes. Data collection and analysis were terminated once thematic saturation was achieved. RESULTS The findings from this study indicated that the mobile health clinic had an inconsistent referral process that was largely dependent on providers' knowledge. Furthermore, clients and providers expressed individual barriers to the referral process, such as financial barriers, and opportunities to improve the referral process, such as an opt-in follow-up from the mobile clinic and increased mobile clinic resources. CONCLUSION The findings in this study underscore the importance of having mobile clinics create a structured referral process that all medical providers are familiar with, and the value of hiring patient navigators that can support and refer clients to care that goes beyond the mobile health clinic setting.
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Affiliation(s)
- Layla Joudeh
- School of Medicine, University of California, San Francisco, USA.
| | - Smith F. Heavner
- grid.26090.3d0000 0001 0665 0280Department of Public Health Sciences at, Clemson University, Clemson, SC USA ,grid.254567.70000 0000 9075 106XDepartment of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.417621.7CDRC, Critical Path Institute, Tucson, AZ USA
| | - Ethan Johnstone
- Pride Link Mobile Community Health Clinic, Greenville, SC USA
| | - Shantara K. Propst
- Edward Via College of Osteopathic Medicine- Carolinas, Spartanburg, SC USA
| | - Orlando O. Harris
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, School of Nursing, University of California, San Francisco, USA ,grid.266102.10000 0001 2297 6811Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA
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Singleton MC, Enguidanos SM. Exploration of Demographic Differences in Past and Anticipated Future Care Experiences of Older Sexual Minority Adults. J Appl Gerontol 2022; 41:2045-2055. [PMID: 35503678 DOI: 10.1177/07334648221098996] [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: 11/17/2022] Open
Abstract
Care experiences of sexual minority (SM) adults are largely characterized by the need for receiving care and providing care to their chosen family. This is due, in part, to the lack of family and social support and higher rates of health disparities. Using data from the "Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans" AARP survey (N = 1694), we examined factors associated with past and anticipated future care experiences among older SMs. Older SM individuals reported high rates of providing care (70%), anticipating future provision of care (71%), and needing care from a loved one (73%). Being older, identifying as female, and having a disability were highly associated with past care experiences. Being female, being in a relationship, and having better self-rated health were highly associated with future anticipated care experiences. These outcomes indicate the importance of having services that are inclusive in serving the SM community.
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Affiliation(s)
- Mekiayla C Singleton
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Susan M Enguidanos
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
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Fingerhut AW, Martos AJ, Choi SK, Abdou CM. Healthcare Stereotype Threat and Health Outcomes Among LGB Individuals. Ann Behav Med 2021; 56:562-572. [PMID: 34244716 DOI: 10.1093/abm/kaab060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND/PURPOSE Health disparities between sexual minorities and heterosexuals are well documented and have been explained by differential access to healthcare as well as exposure to discrimination. The current research examines the role that healthcare stereotype threat, or the fear of being judged by healthcare providers based on negative group stereotypes, plays in the health of LGB individuals. METHODS LGB individuals (N = 1507) in three age cohorts were recruited via random digit dialing to participate in a larger study on sexual minority health. Participants completed measures assessing healthcare stereotype threat, lifetime health diagnoses, life satisfaction, and number of bad physical health days and personal distress in the past 30 days. RESULTS Healthcare stereotype threat was associated with higher psychological distress and number of reported bad physical health days. Additionally, the Younger and Middle cohorts reported more stereotype threat than the Older cohort, but reported significantly higher levels of life satisfaction in the face of this threat than those in the Older cohort. CONCLUSIONS Healthcare stereotype threat was related to poorer mental and physical health among LGB individuals; this was true when these outcomes were assessed over the past 30 days but not when they were assessed in general. Cohort differences in healthcare stereotype threat suggest potential important within group variation that needs further investigating. The research broadens the contexts to which stereotype threat is relevant and establishes a stressor related to LGB health.
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Affiliation(s)
- Adam W Fingerhut
- Department of Psychology, Loyola Marymount University, Los Angeles, CA 90045, USA
| | - Alexander J Martos
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA, USA
| | - Soon Kyu Choi
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA, USA
| | - Cleopatra M Abdou
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Griggs KM, Waddill CB, Bice A, Ward N. Care During Pregnancy, Childbirth, Postpartum, and Human Milk Feeding for Individuals Who Identify as LGBTQ. MCN Am J Matern Child Nurs 2021; 46:43-53. [PMID: 33086216 DOI: 10.1097/nmc.0000000000000675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The growing number of families that include members of sexual and/or gender minority (SGM) groups requires perinatal nurses to know how to provide respectful and affirming care to all people, including this population. Approximately 19% of adults who are members of SGM groups are raising 3 million children, with many hoping to become pregnant, foster, use surrogacy, or adopt in the future. Based on current literature, many nurses are not prepared to meet the clinical needs of patients who are members of SGM groups in the maternity setting. Likewise, patients and families of SGM groups often perceive that nurses are uncomfortable with providing care and are not always satisfied with their care. To meet these needs, it is important that nurses use strategies focused on promoting respectful, affirming care, reducing negative experiences, and eliminating marginalizing language and practices. Nurses must incorporate a holistic care focus for patients who are members of SGM minority groups that includes standardized strategic education; development of Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, or Plus (LGBTQ+) affirming and inclusive policies, practices, and language; flexibility, personal reflection of self-bias; and creating an environment of individualized compassionate care.
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Pachankis JE, Clark KA, Jackson SD, Pereira K, Levine D. Current Capacity and Future Implementation of Mental Health Services in U.S. LGBTQ Community Centers. Psychiatr Serv 2021; 72:669-676. [PMID: 33882684 PMCID: PMC10374348 DOI: 10.1176/appi.ps.202000575] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Since the beginning of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights movement, LGBTQ community centers have been on the front lines of mental health care for sexual and gender minorities (SGMs) across the United States. However, little is known about what types of mental health services LGBTQ community centers currently offer and their anticipated future needs, including training in and delivery of evidence-based practice. METHODS Sixty executive directors and chief executive officers of LGBTQ community centers across the United States completed a survey regarding their centers' current treatment capacity, format, and type as well as perceived future needs. Survey items were supplemented with qualitative questions about perceived barriers to and facilitators of strengthening the capacity of mental health services. RESULTS Center directors perceived a high need for mental health care in their communities and strove to meet that need despite constrained resources. About half of the centers (52%) reported having fewer than five mental health staff; still, most reported providing support groups (98%) and individual psychotherapy (85%). Most centers (88%) reported providing general evidence-based care, such as cognitive-behavioral therapy (62%), and all reported high support for their staff to receive training in more specific types of evidence-based, LGBTQ-affirmative care. CONCLUSIONS LGBTQ community centers continue to play an important role in supporting the mental health of SGMs. The centers also offer a significant opportunity to lead the way in addressing the substantial unmet mental health needs still facing this population by implementing evidence-based, LGBTQ-affirmative practice through efficient and cost-effective service delivery.
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Kirsty A Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Skyler D Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Kobe Pereira
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Deborah Levine
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
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Bunting SR, Chirica MG, Ritchie TD, Garber SS, Batteson TJ. A National Study of Medical Students' Attitudes Toward Sexual and Gender Minority Populations: Evaluating the Effects of Demographics and Training. LGBT Health 2020; 8:79-87. [PMID: 33316199 DOI: 10.1089/lgbt.2020.0288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Evaluating medical students' attitudes toward sexual and gender minority (SGM) people is important to identify negative attitudes early in education and to design curriculum to mitigate biases. The purpose of this study was to investigate medical students' attitudes toward SGM people as a whole as well as specific populations within the SGM community. We sought to determine whether attitudes toward SGM people differed between students' demographics and training. Methods: We conducted an online survey-based study among 1007 medical students at 12 U.S. medical schools. Participants completed the Attitudes Toward LGBT People Scale and were randomized to complete another scale specific to one group within the SGM community. We evaluated the association between student demographics and medical training and attitudes toward SGM people overall and toward specific SGM populations. This study was conducted between January and June 2020. Results: Overall, we found that medical students had positive attitudes toward SGM people and specific SGM groups. The most important factor affecting medical students' attitudes on all scales was religiosity, as very religious students held less positive attitudes toward SGM people. In addition, cisgender female students held more positive attitudes toward SGM people overall and toward specific SGM populations. Conclusion: Medical education must ensure that future physicians receive comprehensive and culturally competent training to prepare them to care for SGM patients. Based on our findings, this training should include specific content to help medical students identify potential biases toward SGM people, as well as strategies to acknowledge and confront these biases.
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Affiliation(s)
- Samuel R Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Marianne G Chirica
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Timothy D Ritchie
- Department of Psychology, Saint Xavier University, Chicago, Illinois, USA
| | - Sarah S Garber
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Tamzin J Batteson
- DeWitt C. Baldwin Institute for Interprofessional Education, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Dickson L, Bunting S, Nanna A, Taylor M, Hein L, Spencer M. Appointment of a Healthcare Power of Attorney Among Older Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Adults in the Southern United States. Am J Hosp Palliat Care 2020; 38:1291-1298. [PMID: 33291959 DOI: 10.1177/1049909120979787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) older adult population may have a heightened need of medical and supportive care while aging. This makes appointment of a healthcare power of attorney (HCPoA) an essential component of end-of-life care to ensure patients' wishes are honored at the end of their lives. The objective of this study was to evaluate the prevalence and preferences for HCPoA appointment among older LGBTQ adults living in the Southern United States. METHODS An online survey was distributed to older LGBTQ adults living in the Southern US regarding appointment of a HCPoA between January-March 2018. PARTICIPANTS The survey was completed by 789 older LGBTQ adults from North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, and Florida in January-March 2018. RESULTS Overall, 61.6% of respondents had appointed a HCPoA. Respondents with an appointed HCPoA were more likely to be married (aOR = 5.04, p < .001), have larger social networks (aOR = 3.87, p < .001) and be older (aOR = 1.07, p < .001). Gender diverse respondents were less likely to have an appointed HCPoA relative to cisgender respondents (aOR = 0.39, p = .04). Overall, the majority of respondents indicated a spouse or significant other served as their HCPoA (n = 311, 64.5%). CONCLUSIONS Nearly 40% of older LGBTQ adults in the Southern US did not have an appointed HCPoA. Specifically, those who were more socially isolated, single, or who identified as transgender or gender non-binary were less likely to have an appointed HCPoA. These people may benefit from targeted outreach regarding advance care planning.
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Affiliation(s)
- Lexus Dickson
- School of Medicine, 12322University of South Carolina, Columbia, SC, USA
| | - Samuel Bunting
- Chicago Medical School, 97174Rosalind Franklin University, North Chicago, IL, USA
| | - Alexis Nanna
- College of Arts and Sciences, 2629University of South Carolina, Columbia, SC, USA
| | - Megan Taylor
- College of Arts and Sciences, 2629University of South Carolina, Columbia, SC, USA
| | - Liam Hein
- College of Nursing, 2629University of South Carolina, Columbia, SC, USA
| | - Mindi Spencer
- 49112Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Menkin D, Tice D, Flores D. Implementing inclusive strategies to deliver high-quality LGBTQ+ care in health care systems. J Nurs Manag 2020; 30:O46-O51. [PMID: 32869409 DOI: 10.1111/jonm.13142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
AIM There is a growing recognition of the need to provide inclusive care for LGBTQ+ individuals. Our aim is to provide guidance for nurse managers contemplating similar inclusive changes in their workplace. The role of nurse managers as change agents is discussed based on our experience transforming a traditional suburban health care system to one that is now more LGBTQ+ inclusive. BACKGROUND LGBTQ+ individuals require and deserve high-quality care. Nurse managers can serve as patient advocates by recognizing their capacity to initiate and sustain changes in care settings. METHODS From our reflective nursing practice, we detail essential components that enabled an incorporation of LGBTQ+ inclusive care practices. To undertake structural changes, we highlight the significance of organisational buy-in, customer service and engagement, changes to physical environment, forms and data collection, initiating staff training and a review of health system policies. RESULTS Systemic change in health care is daunting but is achievable. With support from key stakeholders, nurse managers should be capable of initiating organisational changes that would benefit a patient population in receiving optimal care. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers are in optimum positions to initiate practice changes for inclusive LGBTQ+ health care. This commentary can serve as a template for meaningful organisational changes.
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Affiliation(s)
- Dane Menkin
- Divisional Director, LGBTQ Services Main Line Health, Bryn Mawr, PA, USA
| | - Dawn Tice
- VP, Clinical Operations Main Line HealthCare, Newtown Sq, PA, USA
| | - Dalmacio Flores
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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