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Karniej P, Dissen A, Juárez-Vela R, Santolalla-Arnedo I, Sufrate-Sorzano T, Garrote-Camara ME, Czapla M. Psychometric properties and cultural adaptation of the Polish Version of the Gay Affirmative Practice Scale. Front Public Health 2024; 12:1384429. [PMID: 38756887 PMCID: PMC11097662 DOI: 10.3389/fpubh.2024.1384429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction The lesbian, gay, bisexual, and transgender (LGBT) people often face unique medical disparities, including obstacles to accessing adequate and respectful care. The purpose of this study was to test the psychometric properties(internal consistency, reliability, and factor structure) of the Polish-language version of the Gay Affirmative Practice Scale (GAP-PL). Material The study was conducted over a 6-month period in 2023, from February to June, involving 329 medical students and professionals who evaluated the GAP-PL. Methods Before testing the psychometric properties of the original Gay Affirmative Practice Scale (GAP), it was translated and adapted from the original English language version into the Polish language. Authors then tested the psychometric properties of the tool on a sample of 329 participants. The internal coherence of the questionnaire was tested with the analysis of verifying factors (Confirmatory Factor Analysis). Cronbach alpha and the discriminatory power index were used as internal consistency measures. Results There were more female than male participants (55.32%). More than 53% of the participants were heterosexual, and the average age of the respondents was ~30 years. The internal consistency of the Polish-language version and its domains was strong with the overall Cronbach's alpha ranges for each subscale domains ranging between 0.936 and 0.949. The McDonald's omega coefficient was 0.963. Conclusion The GAP-PL has excellent properties of factorial validity and can be used in research and clinical practice in Polish-speaking populations.
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Affiliation(s)
- Piotr Karniej
- Faculty of Economics, WSB MERITO University in Wroclaw, Wrocław, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
| | - Anthony Dissen
- School of Health Sciences, Stockton University, Galloway, NJ, United States
| | - Raúl Juárez-Vela
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
| | - Iván Santolalla-Arnedo
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
| | - Teresa Sufrate-Sorzano
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
| | | | - Michał Czapla
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- Department of Emergency Medical Service, Wrocław Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
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Lo IPY, Liu EH, Lai DWL, Yan E. Intimate networks of care: Perceptions of intergenerational family care and experiences of ageing among Chinese midlife and older lesbians and gay men. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:762-779. [PMID: 38078806 DOI: 10.1111/1467-9566.13739] [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: 03/01/2023] [Accepted: 11/06/2023] [Indexed: 05/22/2024]
Abstract
This article examines how lesbians and gay men imagine and build their 'intimate networks of care' and negotiate moral expectations towards intergenerational family care as they age. To date, little is known about the strength and complexities of different intimate ties or the role of intergenerational dynamics in shaping ageing sexual minority people's care needs and choices. Based on narrative interviews with ageing Chinese lesbians and gay men, the findings reveal their experiences of constantly juggling their ties with families of origin, moral values around intergenerational care and the urge to receive support from and offer support to chosen networks of people. Participants exercised agency in expanding their networks of care by building friendship and (online and offline) community networks for mutual care and support in later life. Nevertheless, as evidenced by the centrality of ageing with(out) children, and the moral obligation of caring for parents in participants' narratives, participants experienced tensions between enacting what was considered morally right/wrong and developing networks of care that were perceived as emotionally intimate. Linking relational sociology with the sociology of morality, we discuss the conceptual utility of 'intimate networks of care' for sociological theorising of the linkages between sexuality, care and relational lives.
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Affiliation(s)
- Iris Po Yee Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Emma H Liu
- Department of Applied Psychology & Human Development, The University of Toronto, Toronto, Ontario, Canada
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China
| | - Elsie Yan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Lipinski E, Wilson K, Kortes-Miller K, Stinchcombe A. The power of story: Bringing 2SLGBTQ+ digital stories into gerontology settings. GERONTOLOGY & GERIATRICS EDUCATION 2023; 44:540-553. [PMID: 35635188 DOI: 10.1080/02701960.2022.2080674] [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: 06/15/2023]
Abstract
Two-spirit, lesbian, gay, bisexual, trans, and queer or questioning (2SLGBTQ+) older adults are underrepresented in gerontology research and education, impacting the preparedness of health and social care students and professionals working with the diverse aging population. To address this lack of representation of 2SLGBTQ+ older adults in gerontology education, this study explored the use of digital stories as tools for knowledge mobilization and social justice. Digital stories are short videos that pair audio recordings with visuals, including videos, photographs, or artwork. To conduct the study, the research team worked alongside 2SLGBTQ+ older adults to create a suite of three digital stories. These stories were presented at various educational and professional settings in gerontology, and survey and open-feedback responses (n = 147) were gathered from the audience on their perceived impact. Viewers included students, researchers, decision-makers, stakeholders, and citizens. Content analysis was used to analyze the data. From the analysis, digital stories showed the potential to increase viewers' awareness and understanding of 2SLGBTQ+ aging experiences. The format was particularly significant in their learning and enhancing the connection to the content and the storytellers. The findings also suggest that digital stories showed the potential to impact policy and practice for 2SLGBTQ+ communities.
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Affiliation(s)
- Emma Lipinski
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Kimberley Wilson
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Katherine Kortes-Miller
- School of Social Work, Lakehead University, Thunder Bay, Ontario, Canada
- Centre for Education & Research on Aging and Health, Ottawa, Ontario, Canada
| | - Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Rew L, Becker H, Tang M, Liu Y, Wang Y, Croce E. Sensitivity Toward Gender and Sexually Diverse Populations: Development of a Scale. J Nurs Educ 2022; 61:383-389. [PMID: 35858131 DOI: 10.3928/01484834-20220613-01] [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: 11/20/2022]
Abstract
BACKGROUND Individuals who are lesbian, gay, bisexual, transgender, queer, intersex, asexual, or nonbinary (LGBTQIA+) experience inequitable access to and utilization of health care services. Nurses' lack of awareness and sensitivity may contribute to this phenomenon. PURPOSE This article describes the development and validation of the Gender and Sexual Diversity Sensitivity Scale (GSDSS). A sample of 210 undergraduate nursing students from a large research-intensive university completed the scale online. An exploratory factor analysis was conducted. RESULTS Factor analysis illustrated a three-factor construct of the scale (i.e., General Education Experience, Cognitive Awareness, and Comfort With Interactions); Cronbach's alpha coefficients ranged from .66 to .91, and the total scale alpha coefficient was .782. CONCLUSION The GSDSS has evidence of construct validity and reliability, and can be used in studies that include nursing and other health professional students. [J Nurs Educ. 2022;61(7):383-389.].
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Rhoten B, Burkhalter JE, Joo R, Mujawar I, Bruner D, Scout N, Margolies L. Impact of an LGBTQ Cultural Competence Training Program for Providers on Knowledge, Attitudes, Self-Efficacy, and Intensions. JOURNAL OF HOMOSEXUALITY 2022; 69:1030-1041. [PMID: 33905307 DOI: 10.1080/00918369.2021.1901505] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper describes the development and implementation of a robust lesbian, gay, bisexual, transgender, and queer (LGBTQ) cultural competence curriculum for training health and human service providers across New York State. Between 2013-2018, The National LGBT Cancer Network developed and published Best Practices in Creating and Delivering LGBTQ Cultural Competency Trainings for Health and Social Service Agencies and designed a training curriculum. They also conducted Train the Trainer sessions, and evaluated pre- and post- curriculum knowledge, attitudes, self-efficacy and intentions of individuals who attended educational sessions conducted by the certified trainers. Most respondents improved from pretest to posttest, with significant improvements in knowledge, attitudes, self-efficacy and intentions. An increase in self-efficacy was significantly associated with pre- to posttest improvement in respondent intention. Future research should focus on what components specifically bolster self-efficacy and intention. Increasing the number of health and human service providers who are trained to address the needs of this population is an important step toward providing culturally competent care.
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Affiliation(s)
- Bethany Rhoten
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | | | - Rej Joo
- National LGBT Cancer Network, New York, New York, USA
| | - Imran Mujawar
- Centers for Disease Control and Prevention, Washington, DC, USA
| | | | - Nfn Scout
- National LGBT Cancer Network, New York, New York, USA
| | - Liz Margolies
- National LGBT Cancer Network, New York, New York, USA
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Seay J, Hernandez EN, Pérez-Morales J, Quinn GP, Schabath MB. Assessing the effectiveness of a LGBT cultural competency training for oncologists: study protocol for a randomized pragmatic trial. Trials 2022; 23:314. [PMID: 35428352 PMCID: PMC9013168 DOI: 10.1186/s13063-022-06274-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/02/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND LGBT patients may have unique psychosocial cancer care needs, and healthcare providers should have knowledge and understanding of these unique needs to effectively address disparities through the delivery of personalized healthcare. As such, our group developed and piloted a web-based LGBT cultural competency training designed specifically for oncologists called the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS). We designed a randomized pragmatic trial for oncologists to compare the effectiveness of the COLORS training versus a general online LGBT cultural competency training in improving LGBT-related knowledge, attitudes, and clinical practices. METHODS/DESIGN Study procedures include an 8-step approach for recruitment, randomization, retention, and completion of the interventions. Oncologists of any subspecialty who are currently practicing physicians will be identified from the American Medical Association Masterfile. Approximately 5000 oncologists will be sent a FedEx envelope with an invitation letter and study timeline. Electronic consent is obtained using a secure REDCap (Research Electronic Data Capture) portal hosted at the Moffitt Cancer Center (Tampa, FL) where the oncologists will complete the eligibility questionnaire, pre-training assessments, and then will be randomized to complete the COLORS training or an online general healthcare training offered by the National LGBT Health Education Center. Effectiveness of both trainings will be assessed utilizing self-reported measures of LGBT-related knowledge, attitudes, and affirming clinical practices. The measures will be collected before and directly after training completion, as well as 3-month post-training completion. The primary outcomes are changes in knowledge, attitudes, and practice behaviors regarding LGBT cancer patients from pre-test to post-test training in the COLORS training vs. the comparison training. DISCUSSION The overarching premise of this trial is to assess the effectiveness of the COLORS cultural competency training program. If successful, among oncologists who completed the COLORS training should yield statistically significantly improvements in knowledge, attitudes, and affirming practice.
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Affiliation(s)
- Julia Seay
- Naval Health Research Center, San Diego, CA, 92152, USA
| | - Eryk N Hernandez
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL, 33612, USA
| | - Jaileene Pérez-Morales
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL, 33612, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, NY, 10016, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL, 33612, USA.
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL, 33612, USA.
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Henriquez NR, Ahmad N. "The Message Is You Don't Exist": Exploring Lived Experiences of Rural Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) People Utilizing Health care Services. SAGE Open Nurs 2021; 7:23779608211051174. [PMID: 34869861 PMCID: PMC8642108 DOI: 10.1177/23779608211051174] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/31/2021] [Accepted: 09/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) people experience significant health inequities with well-documented negative health impacts due to their status as a sexual and gender minority population. Insensitive or discriminatory attitudes toward LGBTQ people within the health care system have negatively impacted access to health services and the overall physical and mental health and well-being of this at risk population. Few studies of LGBTQ populations in rural areas have been conducted, with even fewer in the Canadian context. Rural areas often create greater visibility for LGBTQ persons, contain fewer supports and alternatives in the face of discrimination, and are often are less accepting of LGBTQ populations due to increased stigma and social isolation. Objective The purpose of this study is to examine the lived experiences of LGBTQ people utilizing health care services in rural Manitoba. Method 12 individuals who self-identified as LGBTQ who had accessed health care services in Manitoba were recruited. Using qualitative methodology, interviews were recorded and analyzed for themes. Results Analysis revealed themes including stigma and discrimination, judgments and assumptions, gender identities, lack of knowledge, limited access/systemic barriers, rural considerations, and recommendations for changes to address the gaps in health care services and barriers to access. Conclusions This study of the LGBTQ community provides an expression of their opinions and experiences, but also provides a voice to this underserved population. The findings of this study provide a better understanding of the unique health needs and experiences of LGBTQ people in rural Manitoba, creating opportunities for meaningful change in health care delivery.
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Affiliation(s)
- Nadine R Henriquez
- Department of Nursing, Faculty of Health Studies, Brandon University, Brandon, Manitoba, Canada
| | - Nora Ahmad
- Department of Nursing, Faculty of Health Studies, Brandon University, Brandon, Manitoba, Canada
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Meanley SP, Plankey MW, Matthews DD, Hawk ME, Egan JE, Teplin LA, Shoptaw SJ, Surkan PJ, Stall RD. Lifetime Prevalence and Sociodemographic Correlates of Multifactorial Discrimination Among Middle-Aged and Older Adult Men Who Have Sex with Men. JOURNAL OF HOMOSEXUALITY 2021; 68:1591-1608. [PMID: 31860386 PMCID: PMC7305044 DOI: 10.1080/00918369.2019.1702353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study describes multifactorial discrimination (discrimination attributed to multiple social identities) among middle-aged and older adult MSM. MSM aged 40+ years (N = 1,193) enrolled in the Multicenter AIDS Cohort Study completed behavioral surveys ascertaining experiences of discrimination and their social identity attributions. Non-proportional odds regressions assessed multifactorial discrimination by age, race/ethnicity, HIV status, and covariates. Twenty-seven percent of participants reported multifactorial discrimination. Adjusted models indicated that middle-aged men were more likely to report multifactorial discrimination compared to older adult men. Racial/ethnic minorities were more likely to report multifactorial discrimination compared to non-Hispanic white participants. These same patterns emerged among the sub-sample of participants living with HIV. To our knowledge, this is the first assessment of multifactorial discrimination in middle-aged and older MSM. Our findings support the deleterious association between multiple-marginalization and multifactorial discrimination. Multilevel interventions targeting interconnected experiences of stigma may improve the health of MSM in transition to older age.
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Affiliation(s)
- Steven P. Meanley
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA
| | - Michael W. Plankey
- Georgetown University Department of Medicine, Division of Infectious Diseases, Washington, DC
| | - Derrick D. Matthews
- University of Pittsburgh Graduate School of Public Health, Department of Infectious Diseases and Microbiology, Pittsburgh, PA
| | - Mary E. Hawk
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - James E. Egan
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - Linda A. Teplin
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL
| | - Steven J. Shoptaw
- University of California – Los Angeles, Department of Family Medicine and Psychiatry and Biobehavioral Sciences, Los Angeles, CA
| | - Pamela J. Surkan
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
| | - Ron D. Stall
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
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Shepherd BF, Brochu PM, Stripling AM. Hidden grief is complicated: identity concealment as a minority stressor and relational-cultural barrier among bereaved sexual and gender minoritized elders. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1970618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Benjamin F. Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
| | - Paula M. Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
| | - Ashley M. Stripling
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
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Wirth M. Demand for Space: Elderly Transgender and Gender Nonconforming People, Healthcare, and Theological Ethics. JOURNAL OF RELIGION AND HEALTH 2021; 60:1713-1728. [PMID: 33106927 PMCID: PMC8137567 DOI: 10.1007/s10943-020-01101-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
Visibility for transgender and gender nonconforming people and the elderly is growing; however, thus far the overlap of the two groups has rarely been considered. Trans persons therefore remain largely invisible in the context of older people's care and medicine. The discrimination faced by this group is at least twofold: they are the targets of aggression incited by transphobia, and also by ageism. Although older trans and gender nonconforming people exist as a greatly marginalized group within another already marginalized group, even the field of theological ethics has neglected to grant them ethical attention. This leads to especially harsh consequences for elderly transgender and gender nonconforming people due to their specific vulnerabilities. There are reports from trans persons who have resolved never to make use of health services again due to regular experiences of transphobia in medical settings. There are religious components within transgender and gender nonconforming issues that should not be overlooked in this context. On the one hand, medical staff, in the name of their Christian beliefs, have refused to provide trans persons with basic medical care. On the other hand, demands for places of visibility, and spaces for the individual, are regularly made in trans-positive studies, and can be linked to discussions within theological ethics about giving space. Some ethical formulas within the Hebrew and Christian traditions focus on the creation of space in which other beings may exist, as found in concepts like brother-sisterhood, friendship, and Sabbath. By casting light on elderly trans and gender nonconforming people, and on their demands for space, via reflections on ethical concepts of space-making, this study develops a specific understanding of space for elderly trans persons. The paper aims to develop an understanding of trans-positive spaces within theological ethics and applied ethics. Spaces that assume a withdrawal or contraction by all those who have previously taken up trans spaces through ignorance, contempt, or violence, should not thereby become spaces of absence: indeed, elderly trans and gender nonconforming people might be in need of both kinds of spaces, those where otherness enables withdrawal, and those where the helping presence of others continues.
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Affiliation(s)
- Mathias Wirth
- Department of Systematic Theology/Ethics, Faculty of Theology, University of Bern, Längassstrasse 51, 3012, Bern, Switzerland.
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11
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Learning to deliver LGBT+ aged care: exploring and documenting best practices in professional and vocational education through the World Café method. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Substantial evidence on the adverse impact of ageing on lesbian, gay, bisexual and transgender (LGBT+) populations through the lack of inclusive care services has highlighted the need for education and training of the health and social care workforce to enhance their skills, knowledge and capabilities in this area. We describe a cross-national collaboration across four European Union countries called BEING ME. This collaboration examined the current pedagogic environment within professional, vocational and community-based education to identify what is most valuable for addressing these needs. The World Café method enabled a process of structured learning and knowledge exchange between stakeholders resulting in: (a) identification of best practices in pedagogies, (b) generation of tailored co-produced educational resources, and (c) recommendations on how to improve the knowledge and capabilities of future care professionals in the area of LGBT+ affirmative practices. Combined with themes from the post-Café evaluation, our findings suggest that underpinning professional and vocational education with a person-in-environment perspective facilitates going some way to acknowledging the historical context of older LGBT+ people's lives. Addressing the unique needs of sub-populations within LGBT+ communities and setting these in the context of holistic and person-centred care may better enable the meeting of their unique diverse needs for ageing. Recommendations are made for learning and teaching strategies to support improved LGBT+ aged care.
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Lindsay S, Kolne K, Barker DJ, Colantonio A, Stinson J, Moll S, Thomson N. Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation. JMIR Form Res 2021; 5:e23568. [PMID: 33720023 PMCID: PMC8075068 DOI: 10.2196/23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/15/2020] [Accepted: 01/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Donna J Barker
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Sandra Moll
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Nicole Thomson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Lindsay S, Kolne K. The training needs for gender-sensitive care in a pediatric rehabilitation hospital: a qualitative study. BMC MEDICAL EDUCATION 2020; 20:468. [PMID: 33238977 PMCID: PMC7690145 DOI: 10.1186/s12909-020-02384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/19/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers. METHODS This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis. RESULTS Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training. CONCLUSIONS Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Jurček A, Downes C, Keogh B, Urek M, Sheaf G, Hafford-Letchfield T, Buitenkamp C, van der Vaart N, Higgins A. Educating health and social care practitioners on the experiences and needs of older LGBT+ adults: Findings from a systematic review. J Nurs Manag 2020; 29:43-57. [PMID: 32881171 DOI: 10.1111/jonm.13145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
AIM(S) To report review findings into interventions used to educate the health and social care workforce on the experiences and needs of LGBT+ older adults. BACKGROUND Research demonstrates that inequalities in outcomes on health and social well-being for LGBT+ older adults are perpetuated by the cumulative disadvantages from discrimination and social exclusion throughout the life course and a lack of culturally competent workforce. METHODS A systematic search of peer-reviewed papers published before February 2020 was conducted in electronic databases. The search resulted in a screening of 2,509 papers with nine matching the inclusion criteria, which were rated using the MERSQI quality measure. RESULTS Studies demonstrated some positive outcomes of interventions, especially an increase in knowledge, but less so in skills and attitudes. DISCUSSION More robust designs such as randomized controlled trials, the use of standardized measures and a focus more on the longitudinal impact of educational interventions could improve the quality of study designs. CONCLUSION(S) Diversification of intervention content and patient and public involvement in the design, delivery and evaluation of educational interventions could improve efforts and have a more sustained impact on LGBT+ ageing inequalities. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers have important roles in supporting staff education and ensuring LGBT+ inclusive practice.
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Affiliation(s)
- Anže Jurček
- Faculty of Social Work, University of Ljubljana, Ljubljana, Slovenia
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Mojca Urek
- Faculty of Social Work, University of Ljubljana, Ljubljana, Slovenia
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin 2, Ireland
| | | | | | | | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
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15
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Lacombe-Duncan A, Logie CH, Persad Y, Leblanc G, Nation K, Kia H, Scheim AI, Lyons T, Loutfy M. 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)': protocol of community-based intervention development and a non-randomised multisite pilot study with pre-post test design in Canada. BMJ Open 2020; 10:e034144. [PMID: 32737085 PMCID: PMC7398088 DOI: 10.1136/bmjopen-2019-034144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Educational workshops are a promising strategy to increase healthcare providers' ability to provide gender-affirming care for transgender (trans) people. This strategy may also reduce healthcare providers' stigma towards trans people and people living with HIV. There is less evidence, however, of educational workshops that address HIV prevention and care among trans women. This protocol details development and pilot testing of the Transgender Education for Affirmative and Competent HIV and Healthcare intervention that aims to increase gender-affirming HIV care knowledge and perceived competency, and to reduce negative attitudes/biases, among providers. METHODS AND ANALYSIS This community-based research (CBR) project involves intervention development and implementation of a non-randomised multisite pilot study with pre-post test design. First, we conducted a qualitative formative phase involving focus groups with 30 trans women and individual interviews with 12 providers to understand HIV care access barriers for trans women and elicit feedback on a proposed workshop. Second, we will pilot test the intervention with 90-150 providers (n=30-50×3 in-person settings). For pilot studies, primary outcomes include feasibility (eg, completion rate) and acceptability (eg, workshop satisfaction). Secondary preintervention and postintervention outcomes, assessed directly preceding and following the workshop, include perceived competency, attitudes/biases towards trans women with HIV, and knowledge needed to provide gender-affirming HIV care. Primary outcomes will be summarised as frequencies and proportions (categorical variables). We will conduct paired-sample t-tests to explore the direction of preintervention and postintervention differences for secondary outcomes. ETHICS AND DISSEMINATION This study has been approved by the University of Toronto HIV Research Ethics Board (Protocol Number: 00036238). Study findings will be disseminated through community forums with trans women and service providers; manuscripts submitted to peer reviewed journals; and conferences. Findings will inform a larger CBR research agenda to remove barriers to engagement in HIV prevention/care among trans women across Canada. TRIAL REGISTRATION NUMBER NCT04096053; Pre-results.
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Women's College Hospital, Toronto, Ontario, Canada
| | - Carmen H Logie
- Women's College Hospital, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Gabrielle Leblanc
- Action Santé Travesti(e)s & Transsexuel(le)s du Québec, Montreal, Québec, Canada
| | - Kelendria Nation
- Prism Education Series, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ayden I Scheim
- Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Tara Lyons
- Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
- Center for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Holman EG, Landry-Meyer L, Fish JN. Creating Supportive Environments for LGBT Older Adults: An Efficacy Evaluation of Staff Training in a Senior Living Facility. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:464-477. [PMID: 32449479 PMCID: PMC8015408 DOI: 10.1080/01634372.2020.1767254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 06/01/2023]
Abstract
Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 hours, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff's cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff's cultural competence affected their perceived readiness to address LGBT elders' needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others' experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.
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Affiliation(s)
- Elizabeth Grace Holman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, Ohio, USA
| | - Laura Landry-Meyer
- Human Development and Family Studies, Bowling Green State University, Bowling Green, Ohio, USA
| | - Jessica N. Fish
- School of Public Health, University of Maryland, College Park, Maryland, USA
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17
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Lindsay S, Kolne K, Rezai M. Challenges with providing gender-sensitive care: exploring experiences within pediatric rehabilitation hospital. Disabil Rehabil 2020; 44:892-900. [DOI: 10.1080/09638288.2020.1781939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Mana Rezai
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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18
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Westwood S, Willis P, Fish J, Hafford-Letchfield T, Semlyen J, King A, Beach B, Almack K, Kneale D, Toze M, Becares L. Older LGBT+ health inequalities in the UK: setting a research agenda. J Epidemiol Community Health 2020; 74:408-411. [PMID: 32086374 DOI: 10.1136/jech-2019-213068] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/21/2020] [Accepted: 02/09/2020] [Indexed: 11/04/2022]
Abstract
Lesbian, gay, bisexual and trans+ (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: (a) social inequalities, including 'minority stress'; (b) associated health-risk behaviours (eg, smoking, excessive drug/alcohol use, obesity); (c) loneliness and isolation, affecting physical/mental health and mortality; (d) anticipated/experienced discrimination and (e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: (1) Production of large data sets; (2) Comparative data collection; (3) Addressing diversity and intersectionality among LGBT+ older people; (4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; (5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and subgroups within this umbrella category; (6) Development of an (older) LGBT+ health equity model; (7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.
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Affiliation(s)
| | - Paul Willis
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Julie Fish
- School of Applied Social Sciences, De Montfort University - City Campus, Leicester, Leicestershire, UK
| | - Trish Hafford-Letchfield
- School of Health & Education, Middlesex University, London, UK.,School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
| | - Joanna Semlyen
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Andrew King
- Department of Sociology, University of Surrey, Guildford, Surrey, UK
| | - Brian Beach
- International Longevity Centre UK, London, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Dylan Kneale
- UCL Institute of Education, University College London, London, UK
| | - Michael Toze
- Lincoln Medical School, University of Lincoln, Lincoln, Lincolnshire, UK
| | - Laia Becares
- Social Work and Social Care, University of Sussex, Brighton, Sussex, UK
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19
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Pedagogical principles and methods underpinning education of health and social care practitioners on experiences and needs of older LGBT+ people: Findings from a systematic review. Nurse Educ Pract 2019; 40:102625. [DOI: 10.1016/j.nepr.2019.102625] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
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20
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Seay J, Hicks A, Markham MJ, Schlumbrecht M, Bowman‐Curci M, Woodard J, Duarte LF, Quinn GP, Schabath MB. Web‐based LGBT cultural competency training intervention for oncologists: Pilot study results. Cancer 2019; 126:112-120. [DOI: 10.1002/cncr.32491] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Julia Seay
- Sylvester Comprehensive Cancer Center Miami Florida
| | - Amanda Hicks
- University of Florida Health Cancer Center Gainesville Florida
| | | | | | | | | | - Luisa F. Duarte
- H. Lee Moffitt Cancer Center & Research Institute Tampa Florida
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21
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Singer RB, Crane B, Lemay EP, Omary S. Improving the Knowledge, Attitudes, and Behavioral Intentions of Perinatal Care Providers Toward Childbearing Individuals Identifying as LGBTQ: A Quasi-Experimental Study. J Contin Educ Nurs 2019; 50:303-312. [PMID: 31233604 DOI: 10.3928/00220124-20190612-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study explores the impact of gender and sexuality awareness training on perinatal health care providers' (HCPs') knowledge, attitudes, and intended behavior toward childbearing individuals identifying as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ). METHOD A nonrandom convenience sample of HCPs (n = 187) comprised an experimental group (n = 99) who attended grand rounds trainings covering gender and sexuality topics and a control group (n = 88) who attended sessions on other unrelated topics. All participants completed a pre-posttraining questionnaire to assess changes in knowledge, attitudes, and intended behavior toward LGBTQ patients. RESULTS Participants in the experimental group demonstrated significant improvement in knowledge, misconception, prejudice, sensitive language, and normativity regarding LGBTQ pregnant patients from pretest to posttest. CONCLUSION These findings suggest that a 40-minute gender and sexuality training can immediately improve HCPs' knowledge, attitudes, and intended behavior toward LGBTQ childbearing patients. [J Contin Educ Nurs. 2019;50(7):303-312.].
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22
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Seay J, Hicks A, Markham MJ, Schlumbrecht M, Bowman M, Woodard J, Kollefrath A, Diego D, Quinn GP, Schabath MB. Developing a web-based LGBT cultural competency training for oncologists: The COLORS training. PATIENT EDUCATION AND COUNSELING 2019; 102:984-989. [PMID: 30642714 DOI: 10.1016/j.pec.2019.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/09/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Despite substantial LGBT cancer health disparities, there are no LGBT cultural competency trainings tailored for oncologists. Here we describe the systematic development of a web-based, oncology-focused LGBT cultural competency training. METHODS A literature review regarding LGBT cancer outcomes and competency training was conducted to identify potential training content. An expert panel meeting, including LGBT cancer survivors, cultural competency experts, oncologists, a web designer, and an instructional designer, was held to solidify the training content focus. Following the panel, the training was developed in collaboration with an instructional designer, a web designer, and LGBT community members. RESULTS The training modules include: 1) LGBT Basics; 2) Inclusive Environments; 3) Initiating Oncology Care with LGBT Patients; and 4) Issues in Cancer Survivorship among LGBT Patients. Module content is interactive, and models effective communication. CONCLUSION The process of collaboration with a diverse group of stakeholders and three cancer centers in Florida has resulted in a practical and efficient web-based resource for LGBT cultural competency training for oncologists. PRACTICE IMPLICATIONS Feedback from stakeholders indicates that training in this area is needed and will be well-received by oncologists. We are currently conducting an evaluation of this training among oncologists and LGBT community members.
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Affiliation(s)
- Julia Seay
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States.
| | - Amanda Hicks
- University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Merry Jennifer Markham
- University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Matthew Schlumbrecht
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Meghan Bowman
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States
| | - Jennifer Woodard
- University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Austin Kollefrath
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Daniela Diego
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Gwendolyn P Quinn
- New York University School of Medicine, 550 First Ave, New York, NY 10016, United States
| | - Matthew B Schabath
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States
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23
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Fredriksen Goldsen K, Kim HJ, Jung H, Goldsen J. The Evolution of Aging With Pride-National Health, Aging, and Sexuality/Gender Study: Illuminating the Iridescent Life Course of LGBTQ Adults Aged 80 Years and Older in the United States. Int J Aging Hum Dev 2019; 88:380-404. [PMID: 30961355 DOI: 10.1177/0091415019837591] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aging with Pride: National Health, Aging, and Sexuality/Gender Study is the first federally funded study addressing aging among LGBTQ older adults throughout the United States. This article examines the evolution of this landmark study and explores the well-being of LGBTQ adults aged 80 years and older ( n = 200), the most underrepresented group in the field. Based on the Iridescent Life Course, we examined the diverse, intersectional nature of LGBTQ older adults' lives, finding high levels of education and poverty. Microaggressions were negatively associated with quality-of-life and positively associated with poor physical and mental health; the inverse relationship was found with mastery. When the oldest encountered risks, it resulted in greater vulnerability. This longitudinal study is assessing trajectories in aging over time using qualitative, quantitative, and biological data and testing evidence-based culturally responsive interventions for LGBTQ older adults. Research with LGBTQ oldest adults is much needed before their stories are lost to time.
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Affiliation(s)
| | - Hyun-Jun Kim
- 1 School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyunzee Jung
- 1 School of Social Work, University of Washington, Seattle, WA, USA
| | - Jayn Goldsen
- 1 School of Social Work, University of Washington, Seattle, WA, USA
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24
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Donaldson W, Smith HM, Parrish BP. Serving All Who Served: Piloting an Online Tool to Support Cultural Competency with LGBT U.S. Military Veterans in Long-Term Care. Clin Gerontol 2019; 42:185-191. [PMID: 30358503 DOI: 10.1080/07317115.2018.1530323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Given health disparities between lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT older adults, ensuring that the care provided in long-term care (LTC) settings is both supportive and sensitive to their unique needs and challenges is essential. This has become a matter of increasing priority in the United States Department of Veterans Affairs (VA), which in recent years has stated its mission to "serve all who served," including LGBT Veterans. With this in mind, we piloted an online training tool designed to enhance the LGBT cultural competence of interdisciplinary staff working in geriatric extended care units. METHOD Interdisciplinary LTC staff participated in an online training module that contained information on unique factors that affect the lives of older LGBT Veterans, and provided considerations and strategies to assist staff in working with them. RESULTS Following participation in the training, staff showed a significant increase in knowledge about LGBT Veterans, but not in skills or attitudes. CONCLUSIONS Online-based LGBT cultural-competency training is useful in providing LTC staff with foundational knowledge that can help them work more competently with LGBT residents. CLINICAL IMPLICATIONS LTC facilities can develop brief yet effective cultural competency trainings that increase the visibility of LGBT concerns in order to enhance clinical care.
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Affiliation(s)
| | - Heather M Smith
- b Clement J. Zablocki VA Medical Center and Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Brendt P Parrish
- c Department of Veterans Affairs , San Diego VA Medical Center , San Diego , California
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25
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Kortes-Miller K, Wilson K, Stinchcombe A. Care and LGBT Aging in Canada: A Focus Group Study on the Educational Gaps among Care Workers. Clin Gerontol 2019; 42:192-197. [PMID: 30453853 DOI: 10.1080/07317115.2018.1544955] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Educational interventions have the potential to equip healthcare providers to support diverse aging populations. The purpose of this research was to identify educational gaps hindering the provision of person-centered care to older adults who identify as LGBT. METHODS Three focus groups were conducted in urban centers in northern, southern, and eastern Ontario with healthcare professionals and frontline staff. Semi-structured focus group discussion guides were developed based on the literature identifying some of the knowledge gaps, attitudes, challenges, and barriers around providing care for older LGBT adults. RESULTS The focus group data revealed several key findings related to 1) lack of curricula within formal education; 2) the need to create safer physical and social environments; and 3) the need to build relationships with LGBT-focused groups/organizations. CONCLUSIONS Care providers want to provide open space for sexual and gender diverse older adults but lack the knowledge to do so. CLINICAL IMPLICATIONS There is an ongoing gap within formal education systems such that historically marginalized populations who are now aging may be systemically neglected within formal curricula.
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Affiliation(s)
- Katherine Kortes-Miller
- a School of Social Work , Lakehead University , Thunder Bay , ON , Canada.,b Centre for Education and Research on Aging and Health (CERAH) , Lakehead University , Thunder Bay , ON , Canada
| | - Kimberley Wilson
- c Department of Family Relations and Applied Nutrition , University of Guelph , Guelph , ON , Canada
| | - Arne Stinchcombe
- d Faculty of Human Sciences , Saint Paul University (Ottawa) , Ottawa , ON , Canada.,e School of Psychology , University of Ottawa , Ottawa , ON , Canada
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26
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Nowakowski ACH, Chan AY, Miller JF, Sumerau JE. Illness Management in Older Lesbian, Gay, Bisexual, and Transgender Couples: A Review. Gerontol Geriatr Med 2019; 5:2333721418822865. [PMID: 30729149 PMCID: PMC6343433 DOI: 10.1177/2333721418822865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/24/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022] Open
Abstract
More openly sexually and gender diverse people are aging into later life across the world as generational transitions occur. People identifying many different ways beyond cisgender and heterosexual are diverse with respect to many other characteristics and sociopolitical locations across the globe and may thus experience a wide array of health journeys both individually and as partners in intimate relationships. In this review article, we summarize the major contributions of and ongoing gaps in existing studies about such couples’ experiences of chronic disease management in later life. We focus on three key groups of findings from prior research about the health of older sexually and/or gender diverse couples: care practices, unmet needs, and diverse resources. We outline priorities for future research within and across these topic areas and in varied locations, with unique recommendations for scholars in both academic and clinical settings. These recommendations support greater integration of such populations, topics, and needs in existing discourse on aging and late life. Likewise, recommendations from this review illuminate potential best practices for engaging and serving these elders in both academic and applied settings.
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Affiliation(s)
| | - Alan Y Chan
- Florida State University College of Medicine, Orlando, FL, USA
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27
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Schweiger-Whalen L, Noe S, Lynch S, Summers L, Adams E. Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community. J Am Psychiatr Nurses Assoc 2019; 25:453-466. [PMID: 30580674 DOI: 10.1177/1078390318820127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions. AIMS: The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, "Converging Cultures," on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers. METHOD: The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote's theory, the process of cultural competence in the delivery of healthcare services. RESULTS: Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote's theory. CONCLUSIONS: Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training.
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Affiliation(s)
| | - Shelly Noe
- Shelly Noe, DNP, PMHNP-BC, RN, New Mexico State University, Las Cruces, NM, USA
| | - Stephanie Lynch
- Stephanie Lynch, PhD, PMHNP-BC, FNP-BC, RN, New Mexico State University, Las Cruces, NM, USA
| | - Linda Summers
- Linda Summers, PhD, FNP-BC, PFNP-BC, RN, New Mexico State University, Las Cruces, NM, USA
| | - Eve Adams
- Eve Adams, PhD, New Mexico State University, Las Cruces, NM, USA
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28
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Bristol S, Kostelec T, MacDonald R. Improving Emergency Health Care Workers’ Knowledge, Competency, and Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Patients Through Interdisciplinary Cultural Competency Training. J Emerg Nurs 2018; 44:632-639. [DOI: 10.1016/j.jen.2018.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 03/09/2018] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
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29
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Putney JM, Keary S, Hebert N, Krinsky L, Halmo R. "Fear Runs Deep:" The Anticipated Needs of LGBT Older Adults in Long-Term Care. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:887-907. [PMID: 30102141 DOI: 10.1080/01634372.2018.1508109] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults' anticipated needs and fears related to nursing homes and assisted living. METHODS This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. RESULTS Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. DISCUSSION This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.
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Affiliation(s)
- Jennifer M Putney
- a Simmons College School of Social Work , Boston , Massachusetts , USA
- b The Fenway Institute , Boston , Massachusetts , USA
| | - Sara Keary
- c Department of Psychiatry , Mount Auburn Hospital , Cambridge , Massachusetts , USA
| | - Nicholas Hebert
- a Simmons College School of Social Work , Boston , Massachusetts , USA
| | - Lisa Krinsky
- b The Fenway Institute , Boston , Massachusetts , USA
| | - Rebekah Halmo
- a Simmons College School of Social Work , Boston , Massachusetts , USA
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Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey. J Gen Intern Med 2018; 33:1654-1660. [PMID: 29761263 PMCID: PMC6153233 DOI: 10.1007/s11606-018-4450-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/08/2017] [Accepted: 04/10/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Transgender people, those whose gender identity does not match their sex assigned at birth, face barriers to receiving health care. These include discrimination, prohibitive cost, and difficulty finding transgender-inclusive providers. As transgender identities are not typically recognized in public health research, the ability to compare the health of the transgender population to the overall population is limited. OBJECTIVE The Colorado Transgender Health Survey sought to explore current disparities and their effects on the health of transgender people in Colorado. DESIGN AND PARTICIPANTS The Colorado Transgender Health Survey, based on the Behavioral Risk Factor Surveillance System (BRFSS), was developed by the Colorado Department of Public Health and Environment, transgender advocates, and transgender community members. Outreach was targeted to transgender-inclusive events and organizations. MAIN MEASURES Responses to the 2014 Colorado Transgender Health Survey were compared side by side to Colorado 2014 BRFSS data. RESULTS Results from 406 transgender or gender-nonconforming adults who live in Colorado were included in the analysis. Forty percent of respondents report delaying medical care due to cost, inadequate insurance, and/or fear of discrimination. Respondents report significant mental health concerns, with 43% reporting depression, 36% reporting suicidal thoughts, and 10% attempting suicide in the past year. Respondents with a transgender-inclusive provider were more likely to receive wellness exams (76 versus 48%), less likely to delay care due to discrimination (24 versus 42%), less depressed (38 versus 54%), and less likely to attempt suicide (7 versus 15%) than those without. CONCLUSIONS The transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities.
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Villar F, Serrat R, Celdrán M, Fabà J, Martínez MT. Disclosing a LGB Sexual Identity When Living in an Elderly Long-Term Care Facility: Common and Best Practices. JOURNAL OF HOMOSEXUALITY 2018; 66:970-988. [PMID: 29927737 DOI: 10.1080/00918369.2018.1486062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aims at exploring staff perceptions of common and best practices toward a situation in which an older resident discloses their non-heterosexual sexual identity, differentiating between gay men, lesbians, and bisexuals. A total of 2,254 staff members from 96 Spanish long-term care facilities took part in the study. They were asked about what they think most of their workmates would do and what they think should be done in a situation in which an older resident discloses his/her non-heterosexual sexual orientation. The results indicate that, in general, staff's attitudes to non-heterosexual older residents' disclosure of their sexual identity are quite tolerant and open. However, differences in staff perceptions of common and best practices indicate that there is still potential for improvement. Results underline that factors such as residents' sexual identity (and particularly, bisexuality), generation, professional position, and the prevailing model of care influence staff responses.
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Affiliation(s)
- Feliciano Villar
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - Rodrigo Serrat
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - Montserrat Celdrán
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - Josep Fabà
- a Department of Developmental and Educational Psychology , University of Barcelona , Barcelona , Spain
| | - M Teresa Martínez
- b Social Services and Rights Department , Principado de Asturias , Oviedo , Spain
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Supporting Lesbian, Gay, Bisexual, & Transgender Inclusivity in Long-Term Care Homes: A Canadian Perspective. Can J Aging 2018; 37:121-132. [PMID: 29553004 DOI: 10.1017/s0714980818000077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTIt is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25). We found that LGBT inclusivity training was the most commonly adopted strategy among the LTC homes surveyed. Study findings further suggested that practices more visible to residents and families, such as LGBT-themed programming, inclusive language and symbols, or joint initiatives with LGBT communities, were less commonly adopted because of anticipated negative resident/family reactions. The importance and benefits of comprehensive strategies that include staff, residents, and family are discussed.
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Staying Out of the Closet: LGBT Older Adults’ Hopes and Fears in Considering End-of-Life. Can J Aging 2018; 37:22-31. [DOI: 10.1017/s0714980817000514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RÉSUMÉLe vieillissement de la population canadienne et l’hétérogéneité des aînés amène une diversité accrue en fin de vie. L’objectif de cette étude était d’aider à combler les lacunes présentes dans la recherche du vieillissement et la fin de vie des personnes LGBT. À l’aide des groupes de discussion, nous avons tenté de mieux comprendre les expériences vécues des individus LGBT plus âgés, afin de mettre en évidence leurs inquiétudes associés aux dernières phases de la vie. Notre analyse démontre que l’identité LGBT est déterminante lorsqu’on considère le vieillissement et les soins en fin de vie. En particulier, l’identité de genre et l’orientation sexuelle sont des facteurs importants par rapport aux liens sociaux, influençant les attentes des individus envers les soins qu’ils reçoivent, à la crainte unique associée à la révélation de son homosexualité et le maintien de l’identité tout au long du vieillissement et des dernières phases de la vie. Cette étude souligne le besoin de considérer l’identité du genre et l’orientation sexuelle en fin de vie. En particulier, la reconnaissance de l’intersectionnalité et des lieux sociaux est essentielle afin de faciliter des expériences positives par rapport au vieillissement et des soins en fin de vie.
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McPhail R, Fulop L. Champions' perspectives on implementing the National Lesbian, Gay, Bisexual, Transgender and Intersex Ageing and Aged Care Strategy in Queensland. AUST HEALTH REV 2018; 40:633-640. [PMID: 26826736 DOI: 10.1071/ah15185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
Abstract
Objective The National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing and Aged Care Strategy was introduced by the Commonwealth Government in 2012. The present study explored perceptions of the first Aged Care Champions (trained employees) of the opportunities, challenges and barriers to implementing the Strategy in Queensland. Methods The present study was an exploratory study of Champions who were nominated by their providers to build capacity around the Strategy for introduction into their organisations. The Champions (n = 62) were surveyed before commencing their training programs. Quantitative and qualitative material was collected on how the Champions perceived the introduction of the six standards within their organisation. Results Champions perceived that there were opportunities to improve inclusivity, leverage organisational support and increase training and support to staff. Key challenges identified were internal attitudes and values, a lack of resources and a need for training and networking. Significant barriers included a lack of management support, resistant staff and pre-existing prejudicial values. Conclusions Providers and practitioners can leverage the opportunity to increase organisational levels of inclusivity, demonstrate organisational support to improve outcomes for clients and stakeholders and, importantly, provide staff training and development critical to the successful implementation of the Strategy. What is known about the topic? Many LGBTI elders have faced a lived history of oppression and discrimination and have special health care needs. As they age, their needs for greater levels of care increase, but for many so to do their concerns about receiving equitable treatment. What does this paper add? The National LGBTI Ageing and Aged Care Strategy was introduced to address the concerns and needs of LGBTI elders and ensure inclusive and supportive care. This study explores the opportunities, challenges and barriers as perceived by employees trained to introduce the Strategy into their services in Queensland. The present study is the first to explore the introduction of the Strategy from employees' perspectives. What are the implications for practitioners? In the present study, the opportunity for increasing inclusivity, levels of support and training and development were explored from an employee perspective, giving voice to this group of practitioners. Challenges, including current attitudes and values of staff and management, as well as a lack of resources and making connections and networks, are identified. Finally, barriers to the implementation of the Strategy are outlined, including levels of support, staff resistance, values and past negative histories of many LGBTI elders.
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Affiliation(s)
- Ruth McPhail
- Griffith Business School, Griffith University, Gold Coast Campus, Qld 4222, Australia. Email
| | - Liz Fulop
- Griffith Business School, Griffith University, Gold Coast Campus, Qld 4222, Australia. Email
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Radix A, Maingi S. LGBT Cultural Competence and Interventions to Help Oncology Nurses and Other Health Care Providers. Semin Oncol Nurs 2018; 34:80-89. [PMID: 29325816 DOI: 10.1016/j.soncn.2017.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To define and give an overview of the importance of lesbian, gay, bisexual, and transgender (LGBT) cultural competency and offer some initial steps on how to improve the quality of care provided by oncology nurses and other health care professionals. DATA SOURCES A review of the existing literature on cultural competency. CONCLUSION LGBT patients experience cancer and several other diseases at higher rates than the rest of the population. The reasons for these health care disparities are complex and include minority stress, fear of discrimination, lower rates of insurance, and lack of access to quality, culturally competent care. Addressing the health care disparities experienced by LGBT individuals and families requires attention to the actual needs, language, and support networks used by patients in these communities. Training on how to provide quality care in a welcoming and non-judgmental way is available and can improve health equity. IMPLICATIONS FOR NURSING PRACTICE Health care professionals and institutions that acquire cultural competency training can improve the overall health of LGBT patients who currently experience significant health care disparities.
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Chaudoir SR, Wang K, Pachankis JE. What reduces sexual minority stress? A review of the intervention "toolkit". THE JOURNAL OF SOCIAL ISSUES 2017; 73:586-617. [PMID: 29170566 PMCID: PMC5695701 DOI: 10.1111/josi.12233] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Sexual orientation health disparities are rooted in sexual minorities' exposure to stress and challenges to effective coping. This paper reviews the "toolkit" of psychosocial interventions available to reduce sexual minority stress effects. A systematic search uncovered 44 interventions that both seek to reduce sexual minority stress at its source in unjust and discriminatory social structures as well as bolster sexual minorities' stigma-coping abilities. These interventions were implemented in a variety of contexts (e.g., education, health care delivery) and utilized heterogeneous modalities to create change (e.g., policy implementation, role-playing activities). They were designed to affect change across structural, interpersonal, and individual levels. The interventions reviewed here, while in early stages of efficacy testing, possess potential for meeting the needs and resources of mental and medical health care providers, policy makers, and other stakeholders who aim to lessen the burden of sexual minority stress and the health disparities it generates.
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Stinchcombe A, Smallbone J, Wilson K, Kortes-Miller K. Healthcare and End-of-Life Needs of Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults: A Scoping Review. Geriatrics (Basel) 2017; 2:E13. [PMID: 31011023 PMCID: PMC6371094 DOI: 10.3390/geriatrics2010013] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/24/2017] [Accepted: 03/06/2017] [Indexed: 11/17/2022] Open
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) older adults face a number of challenges with respect to access to healthcare especially towards end-of-life. Through a systematic search and scoping review of the literature, we sought to answer two related research questions. In particular, the purpose of this scoping review was to determine the healthcare needs of LGBT older adults nearing end-of-life as well as the factors that contribute to a good death experience among older adults who identify as LGBT. A systematic search of electronic databases for articles published between 2005 and 2016 as well as screening for relevance resulted in 25 results. The data were charted and grouped according to the themes of: social support and chosen family, intimacy, health status, fear of discrimination and lack of trust, lack of knowledge and preparedness, and cultural competence in the healthcare system. The results suggest a role for health and social service workers in contributing to a positive care experience for LGBT older adults by becoming knowledgeable about the unique needs of this population and being unassuming and accepting of individuals' sexuality. Many of the articles reviewed collected data outside of Canada, limiting generalizability and highlighting a need for Canadian data on LGBT aging and end-of-life.
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Affiliation(s)
- Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, P7B 5E1, Canada.
| | - Jeffrey Smallbone
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Katherine Kortes-Miller
- School of Social Work, Lakehead University, Thunder Bay, ON, P7B 5E1, Canada.
- Centre for Education and Research on Aging and Health (CERAH), Lakehead University, Thunder Bay, ON, P7B 5E1, Canada.
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Donaldson WV, Vacha-Haase T. Exploring Staff Clinical Knowledge and Practice with LGBT Residents in Long-Term Care: A Grounded Theory of Cultural Competency and Training Needs. Clin Gerontol 2016; 39:389-409. [PMID: 29471770 DOI: 10.1080/07317115.2016.1182956] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Existing literature shows that LGBT residents are likely to face suboptimal care in LTC facilities due to prejudice and discriminatory policies. The aim of this project was to assess the LGBT cultural competency of staff working in LTC facilities, identify their current training needs, and develop a framework for understanding LGBT cultural competency among LTC staff and providers. METHODS This grounded theory study comprised data from focus groups of interdisciplinary staff from three LTC facilities. RESULTS Results suggested that LTC staff struggle with how to be sensitive to LGBT residents' needs. Tension appeared to exist between wanting to provide an equal standard of care to all LTC residents and fearing they would show "favoritism" or "special treatment," which might be viewed as unprofessional. Participants indicated training could help to address the ambivalence they experience about providing sensitive care to subpopulations of residents who face stigma and oppression. CONCLUSIONS LTC staff stand to benefit from cultural competency training focused on LGBT residents. Training should be not only informational in nature, but also facilitate greater self-awareness and self-efficacy with respect to providing care to LGBT people.
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Daley A, MacDonnell JA. 'That would have been beneficial': LGBTQ education for home-care service providers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:282-91. [PMID: 25427428 DOI: 10.1111/hsc.12141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 05/13/2023]
Abstract
This paper reports qualitative findings from a pilot study that explored the lesbian, gay, bisexual, transgender and queer (LGBTQ) education needs of home-care service providers working in one large, urban Canadian city. The pilot study builds upon research that has documented barriers to health services for diversely situated LGBTQ people, which function to limit access to good-quality healthcare. LGBTQ activists, organisations and allies have underscored the need for health provider education related to the unique health and service experiences of sexual and gender minority communities. However, the home-care sector is generally overlooked in this important body of research literature. We used purposeful convenience sampling to conduct four focus groups and two individual interviews with a total of 15 professionally diverse home-care service providers. Data collection was carried out from January 2011 to July 2012 and data were analysed using grounded theory methods towards the identification of the overarching theme, 'provider education' and it had two sub-themes: (i) experiences of LGBTQ education; and (ii) recommendations for LGBTQ education. The study findings raise important questions about limited and uneven access to adequate LGBTQ education for home-care service providers, suggest important policy implications for the education and health sectors, and point to the need for anti-oppression principles in the development of education initiatives.
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Affiliation(s)
- Andrea Daley
- School of Social Work, Faculty of Liberal Arts and Professional Studies, York University, Toronto, ON, Canada
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Porter KE, Cahill S. A State-Level Review of Diversity Initiatives in Congregate Meal Programs Established Under the Older Americans Act. Res Aging 2015; 37:719-40. [PMID: 25651589 DOI: 10.1177/0164027514552330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Older Americans Act (OAA) congregate meal program (CMP) targets those most at risk for nutritional deficiencies, social isolation, and institutionalization. Social minorities (racial, ethnic, cultural, and sexual minorities) are at high risk for all three. This study explores state-level diversity initiatives to welcome these social minorities in CMPs. A national survey was distributed to each State Unit on Aging, all but three states participated. The majority of states (64.6%) target CMPs to a specific racial, ethnic, or cultural minority; five states target sexual minorities (lesbian, gay, bisexual, and transgender [LGBT]). Negative binomial regression results find state minority population percentage is a significant predictor of the number of diversity initiatives at CMPs. States with LGBT CMPs reported the highest levels of racial/ethnic/cultural diversity initiatives and high levels of statewide LGBT protective policies. Recommendations are suggested that build upon the diversification success of states to further the mission of OAA in reaching high-risk older adults.
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Affiliation(s)
- Kristen E Porter
- Department of Gerontology, John E. McCormack School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Sean Cahill
- The Fenway Institute, Boston, MA, USA Wagner School of Public Service, New York University, New York, NY, USA
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Byne W. Forty Years After the Removal of Homosexuality from the DSM: Well on the Way but Not There Yet. LGBT Health 2014; 1:67-9. [PMID: 26789613 DOI: 10.1089/lgbt.2014.1504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William Byne
- The Icahn School of Medicine at Mount Sinai , New York, New York
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