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Gómez-Ibáñez R, Leyva-Moral JM, Cruzado-Reyes A, Platero LR, Granel N, Watson CE. Describing Non-Binary People's Encounters with the Healthcare System: A Qualitative Study in Catalonia (Spain). ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1957-1967. [PMID: 38565788 PMCID: PMC11106161 DOI: 10.1007/s10508-024-02849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1-This is me composed of the categories, "My Name and My Pronouns" and "One's Chosen Gender," and Theme 2-I do not exist for the health system consisting of "Uneducated Health System in Sexual Health" and "Feeling Like an Outsider for Being Non-Binary." Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.
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Affiliation(s)
- Rebeca Gómez-Ibáñez
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Juan M Leyva-Moral
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain.
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain.
| | | | - Lucas R Platero
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Nina Granel
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Carolina E Watson
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
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Rohde A, Goode CK. Using Simulation to Teach Gender-Affirming Care Concepts in Nursing Education. J Nurs Educ 2024; 63:241-246. [PMID: 38581705 DOI: 10.3928/01484834-20240207-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND LGBTQIA+ (lesbian, gay, bisexual, trans-gender, queer or questioning, intersex, asexual), and gender-nonconforming (GNC) individuals have limited access to quality care, leading to health disparities. Lack of training and implicit bias are significant contributors to discrimination. Nursing schools must provide opportunities for student interaction with vulnerable populations, and interacting with transgender and GNC individuals during clinical experiences may be challenging. METHOD Simulated experiences offer opportunities for students to develop clinical competencies. Students participated in a simulation on caring for transgender and GNC populations. Students participated in a prebriefing session, viewed a simulation video, and engaged in a debriefing session. Participants completed a pre- and postsurvey to assess their knowledge and perceived confidence. RESULTS Students' confidence in providing gender affirming care was improved by the activity. CONCLUSION Students prioritize providing competent care to vulnerable populations. In-class simulation is an effective method for improving students' clinical competencies in a safe, nonjudgmental setting. [J Nurs Educ. 2024;63(4):241-246.].
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Alam P, Lin L, Thakkar N, Thaker A, Marston C. Socio-sexual norms and young people's sexual health in urban Bangladesh, India, Nepal and Pakistan: A qualitative scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002179. [PMID: 38377126 PMCID: PMC10878529 DOI: 10.1371/journal.pgph.0002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/20/2024] [Indexed: 02/22/2024]
Abstract
In South Asia, young people face myriad challenges and opportunities regarding their sexual lives relating to varied experiences of norms and restrictions; gender norms and socio-sexual taboos limit communication around sexual health which in turn can affect sexual health outcomes. In this article we focus on norms affecting young people's sexual health experiences in urban settings in Bangladesh, India, Nepal, and Pakistan. We conducted a scoping review of peer reviewed empirical studies based on qualitative data pertaining to young people's experiences of sexuality and sexual health in Bangladesh, India, Nepal, and Pakistan. We searched four electronic databases for articles published (2010-2022), using terms relating to sexual health, young people, and South Asia. Sixteen articles met the inclusion criteria with sample size ranging from 9 to 180. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for the design and analysis of this study. We synthesised the included articles using thematic analysis. The studies covered topics such as sexual health services and contraceptive use; sexuality education and communication; and gender and sexual violence. Recurring findings included: parental and societal expectations around premarital 'sexual purity' through abstinence; limited communication around sexuality between young people and parents/adults; gender norms limiting young women's sexual and reproductive decision making; and an absence of research on experiences of sexual and gender minorities. We identified common themes as well as prominent gaps which must be addressed if we are to capture diverse experiences and build a better evidence base to improve sexual health services for young people in the region. The body of research fails to include experiences of young people with diverse gender, sexual orientation, and sex characteristics.
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Affiliation(s)
- Prima Alam
- Faculty of Public Health and Policy, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
| | - Leesa Lin
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nandan Thakkar
- School of Medicine, University of North Carolina, North Carolina, United States of America
| | - Abhi Thaker
- Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India
| | - Cicely Marston
- Faculty of Public Health and Policy, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Casas-Ramírez M, Martínez-Linares JM, Cortés-Martín JJ, López-Entrambasaguas OM. Trans people perceptions of care received from healthcare professionals - A phenomenological study. Heliyon 2024; 10:e23328. [PMID: 38163130 PMCID: PMC10755318 DOI: 10.1016/j.heliyon.2023.e23328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Trans people have unique health needs and turn to the public health system to meet them. Offering them a more inclusive assistance requires health professionals to know these needs and work on cultural competence. Understanding trans people perceptions of service received will improve therapeutic relationships and the assistance provided to them. Objective To understand trans patients experiences with health care and their perception of care rendered by the Andalusian Public Health System. Design A qualitative phenomenological study according to Ricoeur's hermeneutic approach. Methodology 18 in-depth interviews were conducted between January and April 2022 with trans adult users of the Andalusian Public Health System. These interviews were audio recorded, transcribed and analyzed following the steps proposed by Tan. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study report. Results Three themes were generated from trans patients experiences in the Andalusian Public Health System related to the assistance provided to them: 1) Positive and negative feelings during their pass through the public health system, 2) The importance of being able to receive the care they need, and 3) Having the chosen identity in official documents in order to utterly complete their transition. Conclusion Care rendered by healthcare professionals to trans people was received as positive in mostly cases. However, trans people think these professionals need more training in order to avoid some behaviors they perceive as discriminatory and which they believe tends to pathologize gender identity. They also require more information about the treatments in particular they are about to receive and they demand to end drug shortages. Administrative procedures to change identity are also problematic. So the healthcare system must undergo some modifications in order to become more inclusive.
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Fields EL. Achieving Health Equity for Sexual and Gender-Diverse Youth. Pediatr Clin North Am 2023; 70:813-835. [PMID: 37422316 DOI: 10.1016/j.pcl.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Compared to their heterosexual and cisgender peers, sexual and gender diverse (SGD) youth, especially those from minoritized racial/ethnic groups, experience significant disparities in health, health care, and social conditions that can threaten their health and well-being. This article describes the disparities impacting SGD youth, their differential exposure to the stigma and discrimination that foster these disparities, and the protective factors that can mitigate or disrupt the impact of these exposures. On the final point, the article specifically focuses on pediatric providers and inclusive, affirming, medical homes as critical protective factors for SGD youth and their families.
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Affiliation(s)
- Errol L Fields
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics Johns Hopkins School of Medicine, 200 North Wolfe Street, Room 2015, Baltimore, MD 21287, USA.
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Alam P, Marston C. 'Bending' against straightening devices: queer lived experiences of sexuality and sexual health in Bangladesh. BMC Public Health 2023; 23:173. [PMID: 36698108 PMCID: PMC9878820 DOI: 10.1186/s12889-023-15085-0] [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: 08/23/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite global data around increased health risks among sexual and gender diverse populations, lived experiences of young lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+) people are often ignored in mainstream health research. This is particularly evident in countries such as Bangladesh where the rights of sexual minorities are not recognised. This article looks at queer lived experiences of sexuality and sexual health within such a context. We use the phenomenological framework of heteronormative 'straightening devices' - mechanisms working to direct people towards heterosexuality, gender conformity, and procreative marriage - to identify 'invisible' structures upholding normative sexual behaviours and see how young people in Bangladesh navigate these in their everyday lives. METHODS This article is based on qualitative data collected in Dhaka, Bangladesh over nine months in 2019 as part of the first author's doctoral research. Using thematic analysis, we draw on experiences of normative sexual expectations from biographical in-depth interviews with 14 purposively sampled LGBTQ + individuals aged 18 to 24. RESULTS Respondents identified heteronormative expectations around gender norms of traditional behaviour and presentation for men and women as well as parental expectations of compulsory heterosexuality through marriage. These straightening devices existed at multiple levels, including individual, interpersonal, community, and societal. The four main themes around straightening devices include marriage norms for women; harassment of feminine-presenting bodies in public spaces; heteronormative healthcare; and consequences of not embodying heteronormativity. CONCLUSION Our study highlighted young people's everyday experiences of having to 'bend' to - and against - heteronormative straightening devices at home, in public spaces, and within institutions such as healthcare in Bangladesh. The exploration of queer experiences provides new insights into context-specific ways in which sexual and gender diverse people understand themselves. Further research using the framework of straightening devices can help public health professionals to identify more 'barriers' confronted by sexual and gender diverse young people.
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Affiliation(s)
- Prima Alam
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Cicely Marston
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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