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Mann B, Lanning RK. Improving Knowledge and Competency in Gender-Affirming Patient Care Among New Nurses in Sexual and Reproductive Health Care. Nurs Womens Health 2024:S1751-4851(24)00086-2. [PMID: 38768647 DOI: 10.1016/j.nwh.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/23/2023] [Accepted: 04/09/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To improve knowledge and competency in providing gender-affirming patient care among newly licensed registered nurses (RNs) working in sexual and reproductive health (SRH). DESIGN Pilot, pretest/posttest, descriptive design. SETTING AND PARTICIPANTS Participating RNs were employed at a large academic health center in the southeastern United States. All RNs were providing SRH nursing and participating in the health center's new nurse residency program. METHODS AND INTERVENTION Participants completed an online synchronous training that introduced topics such as sex versus gender, gender dysphoria, and health disparities. This education was followed by in-person training, where an unfolding case study applied concepts to theoretical patient scenarios specific to reproductive health. Participants completed a 20-item survey with a single assessment retrospective pre-post design to measure change in knowledge and competency. RESULTS Twelve RNs participated in this pilot study. Fewer than half had previously received instruction on providing care to trans∗ persons. Seven self-perceived knowledge and competency areas were evaluated with paired retrospective pre-post design questions. All areas measured showed increases from pretraining to posttraining. Participants also had the opportunity to respond to open-ended questions. Common themes identified in these responses include participants planning to maintain a greater awareness and intentionality with language and abandoning cisgender assumptions. Several participants also described health care-specific systemic barriers that could prevent a trans∗ patient from feeling comfortable. CONCLUSION Providing new graduate nurses with education specific to trans∗ patients may help them to feel more knowledgeable and competent when caring for these individuals in SRH settings.
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Smith EK, Harrop EN. "That's not at all what I needed" trans adults' perspectives on trans-affirming primary care and eating disorders. Soc Sci Med 2024; 348:116836. [PMID: 38569289 DOI: 10.1016/j.socscimed.2024.116836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/28/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Transgender and gender diverse adults, referred to collectively as trans, experience eating disorders (EDs) at high rates and struggle to find primary care providers (PCPs) knowledgeable in both gender-affirming care and EDs. Most research regarding healthcare experiences of trans people with EDs focuses on specialized treatment. This qualitative study explored the experiences of trans patients with ED symptoms in trans-affirming primary care, which offers clinical support for gender affirmation in the context of interpersonally gender-affirming primary care services. Twenty-two participants were recruited via social media to participate in focus groups (n = 5). Researchers utilized thematic analysis. Participants reported gender-affirming and non-affirming experiences, experienced unwelcome comments from providers regarding bodies and gender, encountered barriers to disclosing their ED symptoms, felt transition-related medical care supported recovery but did not always resolve their ED symptoms, felt they had to self-advocate, and wanted their providers to recognize them as whole people (beyond their ED and transness) who experience joy. Importantly, despite being trans-affirming, participants critiqued trans-affirming primary care as perpetuating weight stigma and binary gender norms. Participants recommended providers receive ED training, implement universal ED screening, and explore how sociocultural norms regarding weight and gender negatively impact trans health outcomes.
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Affiliation(s)
- Emil K Smith
- University of Pittsburgh School of Social Work, 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
| | - Erin N Harrop
- University of Denver Graduate School of Social Work, 2148 South High Street, Denver, CO, 80208, USA
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3
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Mason KL, Hood KB, Perrin PB, Belgrave FZ, Allison KW, Coston BE. Direct and vicarious exposure to healthcare discrimination and erasure among transgender and gender independent individuals: Testing the indirect effect of mistrust in healthcare on utilization behaviors. Soc Sci Med 2024; 348:116806. [PMID: 38574592 DOI: 10.1016/j.socscimed.2024.116806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
RATIONALE Direct exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, exposure to such harm vicariously (i.e., through observation or report) is underexplored. OBJECTIVE The present study examined the relationships among direct and vicarious gender identity-related healthcare discrimination and erasure exposure and past-year healthcare utilization. METHOD Gender identity-based mistrust in healthcare was also assessed, as a mechanism through which direct and vicarious gender identity-related healthcare discrimination and erasure predict healthcare utilization behaviors among a sample (N = 385) of TGI adults in the U.S., aged 18 to 71 recruited online. RESULTS Results indicated direct lifetime and vicarious healthcare discrimination and erasure exposure significantly predicted past-year healthcare underutilization when participants anticipated encountering gender identity-related healthcare discrimination. Mediational analyses indicated that higher levels of exposure to direct lifetime and vicarious healthcare discrimination and erasure were related to higher levels of mistrust in healthcare, through which past-year underutilization was significantly related. CONCLUSIONS These findings are vital to informing healthcare practice and policy initiatives aimed at ensuring the barriers that deleteriously influence the accessibility of healthcare among TGI individuals are ameliorated.
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Affiliation(s)
- Kyle L Mason
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284, USA.
| | - Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284, USA
| | - Faye Z Belgrave
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284, USA
| | - Kevin W Allison
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin Street, Richmond, VA, 23284, USA
| | - B Ethan Coston
- Department of Gender, Sexuality, & Women's Studies, Virginia Commonwealth University, 919 W Franklin Street, Richmond, VA, 23284, USA
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Borowicz C, Daniel L, Futcher RD, Wilfong DN. Transgender and non-binary patient simulations can foster cultural sensitivity and knowledge among internal medicine residents: a pilot study. Adv Simul (Lond) 2024; 9:12. [PMID: 38509567 PMCID: PMC10956198 DOI: 10.1186/s41077-024-00284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
Transgender and nonbinary patients face unique healthcare challenges, such as harassment, discrimination, and/or prejudice, at higher rates than their cisgender counterparts. These experiences, or even the fear of these experiences, may push patients to delay or forego medical treatment, thus compounding any existing conditions. Such extraneous issues can be combatted through cultural sensitivity. The authors designed blended education consisting of an online module followed by a live simulation to educate and promote sensitivity. Internal medicine (IM) residents (n = 94) completed the module, which introduced them to transgender community terminology and medical disparities, and ways to incorporate affirming behaviors into their practice. Afterward, they engaged in a simulation with true transgender-simulated patients (SPs) - either trans-masculine, trans-feminine, or non-binary. Residents were expected to conduct a patient interview mirroring an intake appointment. Residents then engaged in a debriefing session with the lead investigator and the SP to reflect on the experience, receive feedback and constructive criticism, and ask questions. After the education, the residents' knowledge significantly increased, t(66) = 3.69, p ≤ 0.00, d = 0.45, and their attitude toward members of the transgender community also increased significantly, t(62) = 7.57, p ≤ 0.00, d = 0.95. Furthermore, nearly all residents (99%) reported the training allowed them to practice relevant skills and was a worthy investment of their time. Nearly half (45%) of the residents who listed changes they will make to their practice pledged to ask patients for their preferred name and pronouns. Most comments were positive (75%), praising the education's effectiveness, expressing gratitude, and reporting increased confidence. Results provided evidence that the education was effective in increasing IM residents' knowledge and attitudes. Further research is needed to investigate the longitudinal effects of this education and to extend the education to a broader audience. The investigators plan to adapt and expand the research to other specialties such as gynecology and emergency medicine.
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Affiliation(s)
- Charlie Borowicz
- Center for Inclusion Health at Allegheny Health Network, Pittsburgh, PA, USA.
| | - Laura Daniel
- The Simulation, Teaching, and Academic Research (STAR) Center at Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Donamarie N Wilfong
- The Simulation, Teaching, and Academic Research (STAR) Center at Allegheny Health Network, Pittsburgh, PA, USA
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5
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Wardell S, Withey-Rila C. A critical analysis of trans-visibility through online medical crowdfunding. Soc Sci Med 2024; 345:116682. [PMID: 38413282 DOI: 10.1016/j.socscimed.2024.116682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
In contexts where many people face barriers to accessing gender-affirming care through public systems, some turn to online crowdfunding to fundraise for private care pathways. Crowdfunding platforms invite people to share personal information, stories, and photos publicly, in order to elicit donations. In this article we draw on empirical data from a multimethodological three-year study of medical crowdfunding in Aotearoa New Zealand, with a focus on people crowdfunding for medical transition services. We apply a lens of 'visibility' to analysis of focus groups, interviews, case studies, and campaign pages, presenting findings on who was present and absent (with a focus on binary gender, and whiteness), and who was the assumed or expected audience (with a focus on cis publics). We describe how campaigns were defined by efforts to make trans bodies legible, and campaign requests competitive, through reference to narrow and medicalised frames of dysphoria, suffering, and transformation via medical intervention. We contribute to more comparative work in the literature on crowdfunding by highlighting how these globalised digital technologies are situated in the particular (demographic, cultural, and structural) contexts of Aotearoa New Zealand. We call attention to crowdfunding as a relational practice, in which the public marketisation of the self can have both individual consequences related to privacy and outing, and social consequences, in the reinforcing of trans-normativities. Overall we argue that although crowdfunding represents an adaptive strategy for trans people trying meet their own needs, it ultimately contributes to a type of trans-visibility which is both risky and limiting.
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Thomas SD, King R, Murphy M, Dempsey M. Demographic factors associated with healthcare avoidance and delay in the transgender population: Findings from a systematic review. DIALOGUES IN HEALTH 2023; 3:100159. [PMID: 38515802 PMCID: PMC10954025 DOI: 10.1016/j.dialog.2023.100159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/02/2023] [Accepted: 11/09/2023] [Indexed: 03/23/2024]
Abstract
Purpose Healthcare avoidance and delay (HAD) in the transgender population has been well documented, and research has explored a range of associated factors that help to identify those most at risk of HAD. This review addresses a gap in the research by synthesizing research exploring associations between HAD and demographic factors. Methods A systematic search of literature published at any time up to December 2021 was conducted, using five databases (EBSCO, EMBASE, PubMed, Scopus, and Web of Science) and manually searching reference lists of included studies. After exclusion of duplicates, 608 unique records were subjected to double screening. Papers reporting statistical analyses of HAD in association with any sociodemographic variables were included in this review. Papers consisted of nineteen cross-sectional studies. Narrative synthesis was used to address findings. Results Nineteen studies met inclusion criteria, exploring HAD in association with a wide range of demographic factors, including sex and gender, social transition factors, age, race and ethnicity, socioeconomic factors, veteran status, education, sexuality, relationship status, citizenship, place of residence, and state demographics. Findings identified intra-community demographic risk factors, with consistent evidence for increased HAD among transmasculine, and younger, participants. Lower income and higher educational attainment were also associated with increased HAD, while remaining areas had weak or little evidence for association with HAD. Conclusion This review expands knowledge in this area by highlighting demographic factors associated with increased HAD in research literature, and exploring how these may be further investigated to address substantial gaps in the body of research.
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Affiliation(s)
- Siobhan D. Thomas
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Robert King
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
| | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork Enterprise Centre, North Mall, Cork, Ireland
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Tanenbaum GJ, Holden LR. A Review of Patient Experiences and Provider Education to Improve Transgender Health Inequities in the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6949. [PMID: 37887687 PMCID: PMC10606079 DOI: 10.3390/ijerph20206949] [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: 07/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate healthcare. These inequities are proposed here to be rooted in a lack of education about transgender people and their experiences. We begin by exploring the existing transgender healthcare research carried out in the USA, examining client experiences, provider education and attitudes, and the barriers transgender people face to obtaining proper healthcare. Secondly, we look at the previous research on educational interventions implemented with medical students and practitioners in the USA to enhance knowledge about transgender people, and increase sensitivity and awareness, while also increasing the level of comfort in working with these clients. The limitations in these fields of study are discussed in order to understand how to better serve transgender clients in the USA. We will do this through a narrative review to determine evidence-based best practices for educational intervention, uncovering gaps in the literature and highlighting where to focus in future work for researchers and practitioners.
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Affiliation(s)
- Gabriel J. Tanenbaum
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA;
| | - LaTasha R. Holden
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA;
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Skuban-Eiseler T, Orzechowski M, Steger F. Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals. Int J Equity Health 2023; 22:211. [PMID: 37817187 PMCID: PMC10566060 DOI: 10.1186/s12939-023-02023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Transgender individuals experience limited access to healthcare. This results not least from experiences of discrimination to which they are exposed in the health system. These contribute to transgender individuals having poorer health than cis individuals, i.e. individuals whose sex assigned at birth is in line with their gender identity. It is an ethical duty to take effective measures to minimize inequalities in medical care. At best, such measures should also be assessed as appropriate from the perspective of those affected in order to be accepted and thus effective. It is therefore important to know whether measures touch on the subjectively assumed reasons for experiences of discrimination. Hence, to be able to take appropriate measures, it is important to identify the reasons that transgender individuals see as causal for their experiences of discrimination in healthcare. METHODS We conducted semi-structured interviews with 14 German transgender individuals and asked them about their own experiences of discrimination in healthcare and their assumptions on the reasons for discrimination. We analyzed the responses using the method of structured qualitative content analysis. RESULTS 13 transgender individuals reported experiences of discrimination in healthcare. These emanated from different professional groups and took place in trans-specific as well as general medical settings. We were able to identify a total of 12 reasons that transgender individuals see as causal for their experiences of discrimination: (1) internalized trans-hostility and "protection" of cis individuals, (2) lack of knowledge/uncertainties regarding transition, (3) "protection" of a binary worldview, (4) binary worldview in medicine, (5) structural deficits, (6) asymmetric interactions with specialists, (7) current political debate, (8) view of transgender individuals as a "burden for society", (9) objectification, (10) homophobia, (11) misogyny/androcentrism and (12) discrimination as reaction to discrimination. CONCLUSIONS German transgender individuals have a very differentiated picture regarding their subjective reasons for experiencing discrimination in healthcare. Overall, disrespect regarding gender identity and a confrontation with foreignness seems to be seen as the decisive factor. Thus, it is not enough to focus only on measures that aim to remedy the information deficit on the part of medical providers. Measures must be taken that can create a granting and respectful attitude towards transgender individuals.
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Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany.
- kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
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9
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Clark KD, Lunn MR, Bosse JD, Sevelius JM, Dawson-Rose C, Weiss SJ, Lubensky ME, Obedin-Maliver J, Flentje A. Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study. Int J Equity Health 2023; 22:162. [PMID: 37620832 PMCID: PMC10463432 DOI: 10.1186/s12939-023-01975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently. METHODS We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently. RESULTS Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings. CONCLUSIONS Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings.
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Affiliation(s)
- Kristen D Clark
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
| | - Jordon D Bosse
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, USA
| | - Jae M Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, USA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, 513 Parnassus Avenue, San Francisco, San Francisco, CA, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Sandra J Weiss
- Department of Community Health Systems, UCSF Depression Center, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, 1930 Market Street, San Francisco, CA, USA
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Clark KD, Flentje A, Sevelius JM, Dawson-Rose C, Weiss SJ. Stressors in health care and their association to symptoms experienced by gender diverse people. Public Health 2023; 217:81-88. [PMID: 36867986 PMCID: PMC10354568 DOI: 10.1016/j.puhe.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES Many individuals whose gender does not align with the sex they were assigned at birth (gender diverse [GD] people) report stressful health care encounters. We examined the relationship of these stressors to symptoms of emotional distress and impaired physical functioning among GD people. STUDY DESIGN This study was conducted using a cross-sectional design with data from the 2015 United States Transgender Survey. METHODS Composite metrics of health care stressors and physical impairments were developed, and the Kessler Psychological Distress Scale (K-6) provided a measure of emotional distress. Linear and logistic regression were used to analyze the aims. RESULTS A total of 22,705 participants from diverse gender identity subgroups were included. Participants who experienced at least one stressor in health care during the past 12 months had more symptoms of emotional distress (β = 0.14, P < .001) and 85% greater odds of having a physical impairment (odds ratio = 1.85, P < .001). Transgender men exposed to stressors were more likely than transgender women to experience emotional distress and have a physical impairment, with other gender identity subgroups reporting less distress. Black participants exposed to stressful encounters reported more symptoms of emotional distress than White participants. CONCLUSIONS The results suggest that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms.
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Affiliation(s)
- Kristen D Clark
- Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA; Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, USA
| | - Jae M Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA; Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, CA, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Sandra J Weiss
- Department of Community Health Systems, UCSF Depression Center, University of California, San Francisco, CA, USA
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Boonyapisomparn N, Manojai N, Srikummoon P, Bunyatisai W, Traisathit P, Homkham N. Healthcare discrimination and factors associated with gender-affirming healthcare avoidance by transgender women and transgender men in Thailand: findings from a cross-sectional online-survey study. Int J Equity Health 2023; 22:31. [PMID: 36782169 PMCID: PMC9926841 DOI: 10.1186/s12939-023-01843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Although discriminatory experiences of transgender people seeking healthcare services have been well-documented in several studies, differentiating those experiences based on gender identity/expression and related factors has been limited. The aim of this study was to compare the characteristics, experiences, attitude, and expectation toward accessing healthcare service and healthcare providers of transgender women and transgender men in Thailand. METHODS A cross-sectional study was conducted from October 2017 to March 2018. The data were collected from transgender women and transgender men aged ≥ 18 years old who lived in Thailand using online platform via different websites and Facebook pages of local transgender group. Binary logistic regression was used to identify the factors related to the study outcomes. RESULTS Of 186 transgender people who responded to the questionnaire and were eligible for the study, 73.7% (95% confidence interval [CI] = 66.7-79.8) were transgender women and 26.3% (95% CI = 20.2-33.3) were transgender men. Transgender women were more likely to seek general healthcare from non-traditional healthcare services (crude odds ratio [cOR] = 4.28; 95% CI = 1.55-11.81; P = 0.005), buy hormone treatment from non-traditional healthcare services (cOR = 3.89; 95% CI = 1.18-12.83; P = 0.026), and receive healthcare counseling from non-traditional healthcare providers (cOR = 5.16; 95% CI = 1.42-18.75; P = 0.013) than transgender men. According to the results of applying a multivariable model, transgender respondents who did not know that gender-affirming healthcare services existed in Thailand were more unwilling to receive counseling from gender-affirming healthcare providers than those who did (adjusted odds ratio = 3.70; 95% CI = 1.11-12.36; P = 0.033). CONCLUSIONS The findings from this cross-sectional study indicate that transgender women are more likely than transgender men to receive general healthcare and hormone treatment from non-traditional healthcare services and buy hormone treatment without a physician's supervision. We also found approximately 15% of transgender individuals who did not receive gender-affirming counseling services. Continuing to improve access to care for the transgender community, increasing public relations channels may encourage transgender people to access more healthcare services.
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Affiliation(s)
- Nachale Boonyapisomparn
- grid.427494.8Astraea Lesbian Foundation for Justice, New York, USA ,grid.421854.e0000 0004 1936 9529School of Business and Graduate Studies, Trinity Washington University, Washington, DC USA ,The Foundation of Transgender Alliance for Human Rights, Bangkok, Thailand
| | | | - Pimwarat Srikummoon
- grid.7132.70000 0000 9039 7662Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Walaithip Bunyatisai
- grid.7132.70000 0000 9039 7662Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- grid.7132.70000 0000 9039 7662Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Research Center in Bioresources for Agriculture, Industry and Medicine, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand.
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Rusow JA, Hidalgo MA, Calvetti S, Quint M, Wu S, Bray BC, Kipke MD. Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study. BMC Public Health 2022; 22:2312. [PMID: 36496355 PMCID: PMC9737736 DOI: 10.1186/s12889-022-14585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research. METHODS A total of 108 TGD youth ages 16-24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit. RESULTS Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health-e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)-and elevated rates of illicit drug use (19-85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57-67% reported sex without a condom). CONCLUSIONS This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.
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Affiliation(s)
- Joshua A. Rusow
- grid.4367.60000 0001 2355 7002The Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Marco A. Hidalgo
- grid.417816.d0000 0004 0392 6765Gender Health Program, UCLA Health, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Sam Calvetti
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Meg Quint
- grid.245849.60000 0004 0457 1396The Fenway Institute, Fenway Health, Boston, MA USA ,grid.62560.370000 0004 0378 8294Division of Endocrinology, Diabetes and Hypertension, Transgender Health Research, Brigham and Women’s Hospital, Boston, MA USA
| | - Su Wu
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Bethany C. Bray
- grid.185648.60000 0001 2175 0319Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL USA
| | - Michele D. Kipke
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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Kreines FM, Quinn GP, Cardamone S, Pi GE, Cook T, Salas-Humara C, Fino E, Shaw J. Training clinicians in culturally relevant care: a curriculum to improve knowledge and comfort with the transgender and gender diverse population. J Assist Reprod Genet 2022; 39:2755-2766. [PMID: 36355246 PMCID: PMC9790842 DOI: 10.1007/s10815-022-02655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To design a replicable simulation curriculum collaboratively with the transgender and gender diverse community to improve clinician knowledge and comfort with providing reproductive care to this population. METHODS This is a prospective, single arm pre-post analysis of obstetrics and gynecology residents at a single academic institution after completion of a novel simulation curriculum. The primary outcome was the change in resident comfort and knowledge in providing transgender and gender diverse patient care. A thematic analysis of learner and standardized patient free text responses was analyzed for insights on perceived learner experiences. RESULTS This curriculum was created with iterative feedback from the transgender community and involved only transgender and gender diverse-identified standardized patients. Thirty residents participated, with 22 responding to both the pre-and post-curriculum surveys, and 11 responding to a 6-month post-curriculum survey. There were significant improvements in learner comfort and knowledge after participation that were found to persist at 6 months. Qualitative analysis demonstrated that this was a positive and powerful learning experience for both residents and standardized patients. CONCLUSIONS This simulation curriculum may be an effective and impactful tool to increase trainee comfort and knowledge of transgender and gender diverse patient care, which is important given the lack of physician training in the care for these individuals. By building the foundation with resident learners, the ultimate goal is to enhance the pool of clinicians confident and capable of caring for transgender and gender diverse patients, to increase access to care, and to improve health outcomes in this vulnerable population.
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Affiliation(s)
- Fabiana Maria Kreines
- Department of Obstetrics and Gynecology, New York University Langone Health, NY, New York, USA.
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Langone Health, NY, New York, USA
| | - Stefanie Cardamone
- Department of Obstetrics and Gynecology, New York University Langone Health, NY, New York, USA
- Department of Obstetrics and Gynecology, Stony Brook Medicine, NY, Stony Brook, USA
| | - Guillermo E Pi
- Department of Pediatrics, New York University Langone Health, NY, New York, USA
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tiffany Cook
- Office of Diversity Affairs, New York University Grossman School of Medicine, New York, NY, USA
- UMass Chan Medical School, Diversity and Inclusion Office, Worcester, MA, USA
| | - Caroline Salas-Humara
- Department of Pediatrics, Division of Adolescent Medicine, New York University Langone Health, New York, NY, USA
| | - Elizabeth Fino
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, USA
| | - Jacquelyn Shaw
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, USA
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Lacombe‐Duncan A, Kattari L, Kattari SK, Scheim AI, Alexander F, Yonce S, Misiolek BA. HIV testing among transgender and nonbinary persons in Michigan, United States: results of a community-based survey. J Int AIDS Soc 2022; 25 Suppl 5:e25972. [PMID: 36225152 PMCID: PMC9557000 DOI: 10.1002/jia2.25972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Transgender (trans) and nonbinary people (TNB) are disproportionately impacted by HIV. HIV testing is critical to engage TNB people in HIV prevention and care. Yet, scant literature has examined social and structural factors associated with HIV testing among TNB people of diverse genders and in geographies with potentially lower trans acceptance. We: (1) characterized the prevalence of never having been tested for HIV; and (2) identified associated factors, among TNB people in Michigan, United States. METHODS Data were from a community-based participatory cross-sectional survey (n = 539 sexually experienced TNB people). The prevalence of never having had an HIV test was reported overall and compared across socio-demographic, clinical, social and structural factors using bivariable and multivariable logistic regression analyses. RESULTS AND DISCUSSION Approximately one-quarter (26.2%) of participants had never had an HIV test (20.8% transfeminine; 30.0% transmasculine; 17.8% nonbinary assigned male at-birth; and 32.0% nonbinary assigned female at-birth). In a multivariable socio-demographic model, older age (adjusted odds ratio [aOR] for 1-year increase: 0.93, 95% CI: 0.90, 0.96, p<0.001) and Black/African American race (vs. White) (aOR: 0.28, 95% CI: 0.09, 0.86, p<0.05) were associated with increased odds of HIV testing (aORs for never testing). In separate multivariable models controlling for socio-demographics, ever experiencing sexual violence (aOR: 0.38, 95% CI: 0.21, 0.67, p<0.001), not accessed sexual/reproductive healthcare in the past 12 months (aOR: 4.46, 95% CI: 2.68, 7.43, p<0.001) and reporting a very/somewhat inclusive primary care provider (PCP) (aOR: 0.29, 95% CI: 0.17, 0.49, p<0.001) were associated with HIV testing (aORs for never testing). CONCLUSIONS Findings contribute to scant literature about gender-based differences in HIV testing inclusive of transmasculine and nonbinary people. Lack of statistically significant gender differences suggests that broad TNB interventions may be warranted. These could include training healthcare providers in trans-inclusive practices with sexual violence survivors and PCPs in trans-inclusive HIV prevention and care. Findings showing Black participants were less likely to have never had an HIV test suggest the promise of culturally tailored services, though further investigation is needed. Findings identify social and structural factors associated with HIV testing and can inform multi-level interventions to increase TNB person's HIV testing.
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Affiliation(s)
| | - Leonardo Kattari
- School of Social Work, Michigan State UniversityEast LansingMichiganUSA
| | - Shanna K. Kattari
- School of Social Work, University of MichiganAnn ArborMichiganUSA
- Department of Women's and Gender Studies, University of MichiganAnn ArborMichiganUSA
| | - Ayden I. Scheim
- Dornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Flyn Alexander
- School of Social Work, University of MichiganAnn ArborMichiganUSA
| | - Sophie Yonce
- Lyman Briggs College, Michigan State UniversityEast LansingMichiganUSA
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15
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Eiduson R, Murchison GR, Agénor M, Suarez L, Gordon AR. Sexual healthcare experiences of nonbinary young adults. CULTURE, HEALTH & SEXUALITY 2022; 24:1319-1335. [PMID: 34657546 DOI: 10.1080/13691058.2021.1946595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Nonbinary young adults (who do not identify with a binary male or female identity and may hold diverse gender identities, including genderqueer, nonbinary and agender) may have unique and unmet sexual healthcare needs compared to binary transgender and cisgender people. However, there is limited knowledge about the sexual health and healthcare needs of nonbinary young adults. We conducted 19 semi-structured, in-depth interviews between August and November 2018 with nonbinary people aged 18-30 years in New England. Interview topics included experiences accessing sexual healthcare and engaging in sexual activity. Interviews were transcribed and transcripts were analysed using inductive and deductive thematic analysis. Three main themes were identified. First, participants described barriers to accessing high-quality sexual healthcare at both the interpersonal and institutional level. Second, participants employed strategies to meet their sexual healthcare needs despite encountering barriers. Third, participants articulated the ways nonbinary gender identities affect sexual relationships, with implications for sexual health. These findings underscore the need for research and advocacy - in collaboration with nonbinary persons themselves - to develop best practices to meet the sexual healthcare needs and advance the sexual health of nonbinary young people.
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Affiliation(s)
| | | | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Allegra R Gordon
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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16
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Kinney MK, Cosgrove D. "Truly Listen to Us": Recommendations for Health Professionals to Bolster Wellbeing of Nonbinary Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159032. [PMID: 35897401 PMCID: PMC9330629 DOI: 10.3390/ijerph19159032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
Trans-affirming providers play significant roles in the health and wellbeing of nonbinary individuals. Yet, healthcare mistreatment is well-documented among gender-diverse patients, leading to clients withholding information and avoiding care for fear of experiencing bias. Concurrently, healthcare providers report feeling ill-equipped to serve nonbinary patients, often perpetuating cisnormative binary attitudes. The literature has established the challenges to accessing healthcare and the need for gender-affirming care. However, little is known about nonbinary people’s perspectives on how best to deliver gender-affirming care that is inclusive of nonbinary patients. This participatory action PhotoVoice study identified community member recommendations for healthcare providers to bolster the wellbeing of nonbinary individuals through improved access to gender-affirming healthcare. Data were collected through group discussions, photography, and photo-elicitation interviews. Drawing upon research results, the authors identify recommendations for improving interpersonal care, increasing access to gender-affirming care, and advocating for related environmental and policy changes.
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Affiliation(s)
- M. Killian Kinney
- Claire Argow Social Work Program, Pacific University, Forest Grove, OR 97116, USA
- Correspondence:
| | - Darren Cosgrove
- Department of Family Science & Social Work, Miami University, Oxford, OH 45056, USA;
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17
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Kattari SK, Gross EB, Harner V, Andrus E, Stroumsa D, Moravek MB, Brouwer A. "Doing it on my own terms": Transgender and nonbinary adults' experiences with HPV self-swabbing home testing kits. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2022; 10:496-512. [PMID: 38105788 PMCID: PMC10720596 DOI: 10.1080/23293691.2022.2094737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/19/2022] [Indexed: 12/19/2023]
Abstract
The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties, and even be traumatic at times. This current study is part of a larger mixed methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23-59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: 1) Multilevel barriers; 2) "Get it done, so I know that I am safe"; 3) Contrasting preferences for care; and 4) Community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.
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Affiliation(s)
- Shanna K. Kattari
- School of Social Work & Department of Women’s
and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Emma B. Gross
- School of Social Work, Department of Psychology,
University of Michigan, Ann Arbor, MI, USA
| | - Vern Harner
- School of Social Work, University of Washington, Seattle,
WA, USA
| | - Emily Andrus
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
| | - Daphna Stroumsa
- Medical School, Department of Obstetrics and Gynecology
& Institute for Healthcare Policy and Innovation, University of Michigan, Ann
Arbor, MI, USA
| | - Molly B. Moravek
- Medical School, Department of Obstetrics and Gynecology,
University of Michigan, Ann Arbor, MI, USA
| | - Andrew Brouwer
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
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18
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Exposure to Childhood Healthcare Discrimination and Healthcare Avoidance among Transgender and Gender Independent Adults during a Global Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127440. [PMID: 35742688 PMCID: PMC9223811 DOI: 10.3390/ijerph19127440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Transgender and gender-independent individuals (TGI) encounter myriad barriers to accessing affirming healthcare. Healthcare discrimination and erasure exposure among TGI individuals is vital to understanding healthcare accessibility, utilization behaviors, and health disparities in this population. Exposure to gender identity-related healthcare discrimination and erasure in childhood may contribute to TGI adults' healthcare utilization behaviors. The commonality of childhood exposure to gender identity-related healthcare discrimination and its relationship to healthcare avoidance during the early months of the COVID-19 pandemic among TGI adults were explored. TGI adults aged 18 to 59 (N = 342) in the United States were recruited online during the summer of 2020. Among individuals who reported childhood exposure to gender identity-related healthcare discrimination, 51% reported experiencing two or more distinct forms of discrimination. Hierarchical logistic regression indicated that exposure to healthcare discrimination in childhood significantly increased the odds of healthcare avoidance during the early months of the COVID-19 pandemic, after accounting for demographic factors and self-reported COVID-19 symptoms (odds ratio = 1.30, 95% confidence interval = 1.10, 1.54). These findings suggest that childhood exposure to gender identity-related healthcare discrimination is a prominent barrier to the utilization of healthcare for TGI adults, even during a global pandemic.
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19
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Levin NJ, Zhang A, Kattari S, Moravek M, Zebrack B. "Queer Insights": Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2022; 3:111-128. [PMID: 38078047 PMCID: PMC10704859 DOI: 10.1891/lgbtq-2021-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This article addresses issues related to clinical and research approaches to oncofertility for adolescent and young adult (AYA) sexual and gender minority (SGM) cancer patients. Limited attention has been dedicated to understanding the extent to which oncofertility services are appropriately and equitably delivered to AYAs with diverse orientations toward sexual orientation, gender identity, and future family. Unresolved challenges to conducting research with this vulnerable population perpetuate a lack of adequate knowledge about SGM AYA oncofertility needs. Therefore, the purpose of this paper is to inform considerations of sex, gender identity, and sexual orientation for investigations that include SGM AYAs. In order to improve the knowledge base and clinical services for this population, we discuss (1) challenges to sampling this population; (2) categorization and survey logic (e.g., skip patterns) in light of fluid sexual orientation and gender identities; and (3) clinical implications of accurately assessing sex and gender for oncofertility research and practice. We also recommend strategies for producing inclusive and accurate assessments of sexual and gender identity categories in both research and clinical encounters with SGM AYAs. Incorporating "queer insights" into empirical research - that is, positioning queer theory at the center of oncofertility study design - is suggested as a future direction for oncofertility research and practice.
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Affiliation(s)
- Nina Jackson Levin
- University of Michigan, School of Social Work and Department of Anthropology
| | - Anao Zhang
- University of Michigan, School of Social Work
| | - Shanna Kattari
- University of Michigan, School of Social Work and Department of Women’s and Gender Studies
| | - Molly Moravek
- University of Michigan, Department of Obstetrics and Gynecology and Department of Urology, Ann Arbor, MI, USA
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20
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Lerner JE, Martin JI, Gorsky GS. To Go or Not to Go: Factors That Influence Health Care Use Among Trans Adults in a Non-Representative U.S. Sample. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1913-1925. [PMID: 35596036 DOI: 10.1007/s10508-022-02302-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 06/15/2023]
Abstract
Trans people tend to utilize health care at rates lower than cisgender people, which commonly results in short-term and long-term unfavorable health outcomes. Theoretically informed by Andersen's behavioral model of health services use and Lerner and Robles' adapted behavioral model of health services use for transgender people, the current study examined how individual characteristics of trans people along with the external environment and health care service environment they must navigate impact their health care utilization. Binary logistic regression was used to analyze data from the 2015 United States Trans Survey (N = 27,715), the largest trans sample to date. Perception of health care provider (HCP) knowledge, health insurance status, and health care costs each produced the strongest effect on visiting a doctor or HCP in the past year. The results showed that having a provider that had some level of knowledge about trans people was potentially most critical to increase utilization. Discussion points include increasing trans-focused curriculum in health professional schools, utilizing trans standardized patients in health professional schools, and holding insurance companies accountable to provide trans affirming care.
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Affiliation(s)
- Justin E Lerner
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA.
| | - James I Martin
- School of Social Work, New York University, New York, NY, USA
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21
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Kinney MK, Pearson TE, Ralston Aoki J. Improving "Life Chances": Surveying the Anti-Transgender Backlash, and Offering a Transgender Equity Impact Assessment Tool for Policy Analysis. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:489-508. [PMID: 36398638 PMCID: PMC9679585 DOI: 10.1017/jme.2022.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Transgender inclusion within policy is critical yet often missing. We propose a policy tool to assesses human rights, access to resources and opportunities, language, and implications for transgender and nonbinary individuals. Acknowledging trans communities as standard policy practice can serve as an essential practice to shift dialogue and norms.
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22
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Exploring the Experiences of Transgender and Gender Diverse Adults in Accessing a Trans Knowledgeable Primary Care Physician. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413057. [PMID: 34948676 PMCID: PMC8701045 DOI: 10.3390/ijerph182413057] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 01/26/2023]
Abstract
Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender diverse individuals in accessing care, but there is a clearly indicated need for additional education for healthcare providers, especially those doing primary care, on how to offer knowledgeable, affirming, and intersectional care to their patients.
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Trans-affirming care: An integrative review and concept analysis. Int J Nurs Stud 2021; 123:104047. [PMID: 34454333 DOI: 10.1016/j.ijnurstu.2021.104047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 05/23/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Contemporary healthcare exists within a cisnormative landscape which underpins the erasure of trans persons in healthcare, health research, and health education, and results in negative experiences and poorer outcomes. Further, nurses report feeling inadequately prepared to provide affirming care to trans patients, with little guidance available to inform their practice. OBJECTIVE To explore the conceptual understanding of trans-affirming care as it pertains to nursing, and to provide recommendations for trans-affirming nursing care at the systemic, organizational, and individual level. METHODS A systematic search of the literature was completed using standard review processes. Two reviewers independently applied a two-step study selection procedure to identify eligible citations. Walker and Avant's concept analysis method was used to analyze the extracted data to determine antecedents, defining attributes, empirical referents, and consequences. RESULTS Of the 5914 studies, 136 met criteria, representing a variety of clinical settings. The antecedents identified were depathologization of gender variance and cultural humility. The defining attributes were patient-led care, trans-affirming culture, and trans-competent providers. The consequences were improved psychological and physical health outcomes. CONCLUSIONS Trans persons and communities are becoming more visible in society, as are their testimonials about their substandard treatment within healthcare systems. Nurses need to respond to these health inequities with self-reflection, advocacy, and education. At the center of this work is the concept of trans-affirming care, which is a philosophy of care specific to trans persons. Tweetable abstract: This article offers an evidence-informed definition of trans-affirming care and recommendations for how it can be operationalized by nurses.
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Redcay A, Bergquist K, Luquet W. On the Basis of Gender: A Medical-Legal Review of Barriers to Healthcare for Transgender and Gender-Expansive Patients. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:615-627. [PMID: 34340636 DOI: 10.1080/19371918.2021.1942378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Transgender individuals will seek medical intervention for transition-related services as well as medical treatment for general health needs similar to cisgender individuals. However, people in the transgender community face unique barriers to treatment such as the lack of knowledge among health-care professionals, insurance coverage, and legal protections. This paper reviews barriers, major legal cases, and federal policy related to the health needs for transgender and gender expansive individuals. The authors call for a social work response at the macro and micro level. Advocacy for health care access for transgender individuals is a social justice issue social workers are uniquely positioned to work toward. At the micro level, social workers must help educate and advocate for their clients to bring transgender-sensitive practices to the health care system.
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Affiliation(s)
- Alex Redcay
- School of Social Work, Millersville University, Millersville, Pennsylvania, USA
| | - Kathleen Bergquist
- School of Social Work, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Wade Luquet
- Bachelor of Social Work Program, Gwynedd Mercy University, Gwynedd Valley, Pennsylvania, USA
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Rosenberg S, Callander D, Holt M, Duck-Chong L, Pony M, Cornelisse V, Baradaran A, Duncan DT, Cook T. Cisgenderism and transphobia in sexual health care and associations with testing for HIV and other sexually transmitted infections: Findings from the Australian Trans & Gender Diverse Sexual Health Survey. PLoS One 2021; 16:e0253589. [PMID: 34288911 PMCID: PMC8294496 DOI: 10.1371/journal.pone.0253589] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Transgender and gender diverse people have unique risks and needs in the context of sexual health, but little is known about sexual health care for this population. In 2018, a national, online survey of sexual health and well-being was conducted with trans and gender diverse people in Australia (n = 1,613). Data from this survey were analysed to describe uptake of sexual health care and experiences of interpersonal and structural cisgenderism and transphobia. Experiences of cisgenderism and transphobia in sexual health care were assessed using a new, four-item scale of 'gender insensitivity', which produced scores ranging from 0 (highly gender sensitive) to 4 (highly gender insensitive). Logistic and linear regression analyses were conducted to determine if experiences of gender insensitivity in sexual health care were associated with uptake and frequency of HIV/STI testing in the 12 months prior to participation. Trans and gender diverse participants primarily accessed sexual health care from general practice clinics (86.8%), followed by publicly funded sexual health clinics (45.6%), community-based services (22.3%), and general hospitals (14.9%). Experiences of gender insensitivity were common overall (73.2% of participants reported ≥2 negative experiences) but most common in hospitals (M = 2.9, SD = 1.3) and least common in community-based services (M = 1.3, SD = 1.4; p<0.001). When controlling for sociodemographic factors, social networks, general access to health care, and sexual practices, higher levels of gender insensitivity in previous sexual health care encounters were associated with a lower likelihood of recent HIV/STI testing (adjusted prevalence ratio = 0.92, 95% confidence interval [CI]:091,0.96, p<0.001) and less-frequent HIV/STI testing (B = -0.07, 95%CI:-0.10,-0.03, p = 0.007). Given the high rates of HIV and other STIs among trans and gender diverse people in Australia and overseas, eliminating cisgenderism and transphobia in sexual health care may help improve access to diagnostic testing to reduce infection rates and support the overall sexual health and well-being of these populations.
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Affiliation(s)
- Shoshana Rosenberg
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
- Centre for Human Rights Education, Curtin University, Perth, Western Australia, Australia
| | - Denton Callander
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Liz Duck-Chong
- AIDS Council of New South Wales (ACON), Sydney, New South Wales, Australia
| | - Mish Pony
- Scarlet Alliance, Australian Sex Workers Association, Sydney, New South Wales, Australia
| | - Vincent Cornelisse
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Kirkton Road Centre, Sydney, New South Wales, Australia
| | - Amir Baradaran
- School of the Arts, Columbia University, New York, New York, United States of America
| | - Dustin T. Duncan
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Teddy Cook
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- AIDS Council of New South Wales (ACON), Sydney, New South Wales, Australia
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Markovic L, McDermott DT, Stefanac S, Seiler-Ramadas R, Iabloncsik D, Smith L, Yang L, Kirchheiner K, Crevenna R, Grabovac I. Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136895. [PMID: 34199049 PMCID: PMC8297154 DOI: 10.3390/ijerph18136895] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients' experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician-patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient-physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations.
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Affiliation(s)
- Lovro Markovic
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Daragh T. McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham NG1 4FQ, UK;
| | - Sinisa Stefanac
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Radhika Seiler-Ramadas
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
| | - Darina Iabloncsik
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
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Garnier M, Ollivier S, Flori M, Maynié-François C. Transgender people's reasons for primary care visits: a cross-sectional study in France. BMJ Open 2021; 11:e036895. [PMID: 34168020 PMCID: PMC8231050 DOI: 10.1136/bmjopen-2020-036895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our main objective was to describe transgender people's reasons for consulting a general practitioner (GP) outside of transition-related issues; the secondary objective was to study the qualitative aspects of the primary care visits for this population. DESIGN Descriptive, cross-sectional study in France. SETTING The study questionnaire was distributed online and to healthcare centres in France. PARTICIPANTS Self-identified transgender people aged 18 and older. PRIMARY AND SECONDARY OUTCOMES Reasons for consulting were collected retrospectively and classified according to the International Classification of Primary Care, second edition (ICPC-2). The answers to the open-ended questions were analysed qualitatively by theme and occurrences. RESULTS Out of 320 respondents, 50% visited their GP for a problem unrelated to their transition, with a total of 155 reported reasons. Procedures such as prescription renewal and administrative paperwork represented 33% of the reasons to visit, followed by general symptoms (15%). Benevolence from the physician was the most important criteria for a successful consultation. CONCLUSION Transgender people visit their GP for reasons either related (50%) or unrelated (50%) to transition. When unrelated, reasons appear to be similar to the reasons found in the general population. Further research and training should be developed on comprehensive primary healthcare for transgender people to provide quality patient-centred care for transgender patients.
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Affiliation(s)
- Maud Garnier
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Sarah Ollivier
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Flori
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Christine Maynié-François
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
- UMR CNRS 5558, Laboratoire de biométrie et biologie évolutive (LBBE), équipe Evaluation et modélisation des effets thérapeutiques (EMET), Université Claude Bernard Lyon 1, Lyon, France
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28
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Gomez AM, Hooker N, Olip-Booth R, Woerner P, Ratliff GA. "It's Being Compassionate, Not Making Assumptions": Transmasculine and Nonbinary Young Adults' Experiences of "Women's" Health Care Settings. Womens Health Issues 2021; 31:324-331. [PMID: 33875320 DOI: 10.1016/j.whi.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transgender and nonbinary (TNB) individuals assigned female sex at birth experience discrimination, misgendering, problems with insurance, and denial of services when accessing health care. This study aimed to understand the experiences of TNB young adults in accessing "women's" health care-a form of care that is structurally gendered that few studies have investigated. METHODS In 2015, we conducted in-depth interviews with 20 TNB young (ages 18-29) adults assigned female sex at birth. We thematically analyzed the data. RESULTS Participants described feelings of comfort and trust-and lack thereof-at every step of the health care-seeking process, including scheduling, checking in, waiting, and interactions with clinicians and other staff. Gendered language served as a constant stressor; participants-especially nonbinary participants-noted few opportunities to provide their correct pronouns and names. Participants relayed negative experiences associated with waiting rooms in "women's" health care spaces, where TNB patients are forced to disclose their identity simply through their presence or owing to actions of staff that out them. These concerns deterred some from seeking care, with most expressing discomfort or anxiety that caused them to feel unsafe. Participants described "women's" health care providers making assumptions about their anatomy, reproductive desires, sexual orientation, and sexual practices, as well as inappropriately and harmfully emphasizing their bodies and TNB identities during health care interactions. Clinician competence and humility engendered participants' feelings of safety and undergirded their interest in engaging with "women's" health care. CONCLUSIONS A lack of patient-centered, TNB-competent care in structurally gendered health settings exacerbates health care and health inequities for TNB young adults.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California.
| | - Noah Hooker
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Robin Olip-Booth
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Phoebe Woerner
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - G Allen Ratliff
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
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29
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McQuillan MT, Kuhns LM, Miller AA, McDade T, Garofalo R. Gender Minority Stress, Support, and Inflammation in Transgender and Gender-Nonconforming Youth. Transgend Health 2021; 6:91-100. [PMID: 33937526 DOI: 10.1089/trgh.2020.0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Transgender and gender-nonconforming (TGNC) youth often report higher rates of chronic social stressors such as victimization, discrimination, and rejection. Some of these gender-based stressors may have long-range physical health consequences through inflammation pathways. This study evaluates the feasibility and acceptability of adding biological measures of inflammation to an ongoing prospective clinical study of TGNC youth (ages 9-20 years), initiating affirming medical therapy at a large, urban children's hospital (N=56). We also examine the relationship between gender-based sources of stress and support with inflammation. This is the first study to explore how gender identity, social stressors, and social supports may contribute to poorer health in TGNC youth through inflammation and immune dysregulation pathways. Methods: Between October 2016 and August 2018, the study team collected dried blood spot (DBS) samples and health measures during clinical visits. Participants also completed computer-assisted surveys assessing gender minority stress and support during these visits. We used regression analysis to evaluate differences in C-reactive protein (CRP) controlling for demographics, health, gender-based stress, and supports. Results: The results from this study indicate that adding DBS samples to assess inflammation was feasible and acceptable in a clinical sample of TGNC youth seeking affirming-medical interventions. We found an association between greater inflammation and the composite score for greater gender-based stressors and lower gender-based supports using the Gender Minority Stress and Resilience Tool (GMSR); however, we did not find statistically significant differences in CRP associated with any of the individual GMSR subscales assessing various types of gender-based supports or stressors. Conclusion: More research is necessary to evaluate how different sources of gender-based support and stress relate to inflammation with larger sample sizes.
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Affiliation(s)
- Mollie T McQuillan
- Department of Educational Leadership and Policy Analysis, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lisa M Kuhns
- Department of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aaron A Miller
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Robert Garofalo
- Department of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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30
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Eberman LE, Winkelmann ZK, Nye EA, Walen DR, Granger KC, Walker SE. Providing Transgender Patient Care: Athletic Trainers' Compassion and Lack of Preparedness. J Athl Train 2021; 56:252-262. [PMID: 33237999 DOI: 10.4085/1062-6050-0501.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Previous researchers have indicated that athletic trainers (ATs) had a favorable view of treating transgender patients, yet the ATs did not perceive themselves as competent in their patient care knowledge or abilities. OBJECTIVE To gain more in-depth information about ATs' knowledge and experiences regarding the health care needs of transgender student-athletes. DESIGN Mixed-methods study. SETTING Individual, semistructured follow-up interviews. PATIENTS OR OTHER PARTICIPANTS Fifteen ATs (4 men, 10 women, 1 transgender female; age = 34 ± 9 years, experience = 11 ± 8 years) who took part in a cross-sectional survey in April 2018. MAIN OUTCOME MEASURE(S) The interviews were audio recorded and transcribed verbatim. Member checking was completed to ensure trustworthiness of the data. Next, the data were analyzed via a multiphase process and 3-member coding team who followed the consensual qualitative research tradition. The coding team analyzed the transcripts for domains and categories. The final consensus codebook and coded transcripts were audited by a member of the research team for credibility. RESULTS Four main domains were identified: (1) perceived deficiencies, (2) misconceptions, (3) concerns, and (4) creating safety. Participants described knowledge deficiencies in themselves, health care providers within their units, and providers able to provide safe transition care. The ATs demonstrated misconceptions when defining transgender and transitioning and when describing how the body responds to hormone replacement therapy. They expressed concern for the mental health and wellness, self-image, and potential cost of transgender health care for transgender student-athletes. However, participants also described efforts to create safety within their units by validating transgender patients, instilling trust, adjusting the physical environment, and engaging in professional development to improve their knowledge. CONCLUSIONS Athletic trainers wanted to create a safe space for transgender student-athletes but lacked the necessary knowledge to treat transgender patients. Professional resources to improve their knowledge, skills, and abilities in caring for transgender patients are a continuing need.
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Affiliation(s)
- Lindsey E Eberman
- Neuromechanics, Interventions, and Continuing Education Research (NICER) Laboratory, Indiana State University, Terre Haute
| | | | | | | | - Kelcey C Granger
- Neuromechanics, Interventions, and Continuing Education Research (NICER) Laboratory, Indiana State University, Terre Haute
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31
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Poquiz JL, Coyne CA, Garofalo R, Chen D. Comparison of Gender Minority Stress and Resilience Among Transmasculine, Transfeminine, and Nonbinary Adolescents and Young Adults. J Adolesc Health 2021; 68:615-618. [PMID: 33046360 PMCID: PMC8479649 DOI: 10.1016/j.jadohealth.2020.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study examined whether transmasculine, transfeminine, and nonbinary adolescents and young adults (AYA) experience different levels of gender minority stress and resilience. METHODS Demographic and clinical information were abstracted from medical charts from AYA initiating gender-affirming care. Group comparisons between transgender and nonbinary groups were examined using one-way analyses of variance and Tukey's honestly significant difference post hoc tests. RESULTS Participants were 638 transgender and nonbinary AYA (65.5% transmasculine, 24.6% transfeminine, and 9.9% nonbinary). Transmasculine and transfeminine AYA reported more discrimination (ps = .008 and .006, respectively) compared to non-binary AYA. Transfeminine and nonbinary AYA reported more negative future expectations (ps = .006 and .016, respectively) and pride (ps ≤ .001 and .032, respectively) than transmasculine AYA. CONCLUSIONS Findings suggest that transmasculine, transfeminine, and nonbinary AYA experience different levels of gender minority stress and resilience. Future research is warranted to further examine between-group differences and differential impact on mental health outcomes.
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Affiliation(s)
- Jonathan L. Poquiz
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Address correspondence to: Jonathan Poquiz, Ph.D., Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 161, Chicago, IL 60611-2605. (J.L. Poquiz)
| | - Claire A. Coyne
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert Garofalo
- Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane Chen
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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32
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Kcomt L, Gorey KM, Barrett BJ, McCabe SE. Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments. SSM Popul Health 2020; 11:100608. [PMID: 32529022 PMCID: PMC7276492 DOI: 10.1016/j.ssmph.2020.100608] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/01/2022] Open
Abstract
Transgender people encounter interpersonal and structural barriers to healthcare access that contribute to their postponement or avoidance of healthcare, which can lead to poor physical and mental health outcomes. Using the 2015 U.S. Transgender Survey, this study examined avoidance of healthcare due to anticipated discrimination among transgender adults aged 25 to 64 (N = 19,157). Multivariable logistic regression analysis was conducted to test whether gender identity/expression, socio-demographic, and transgender-specific factors were associated with healthcare avoidance. Almost one-quarter of the sample (22.8%) avoided healthcare due to anticipated discrimination. Transgender men had increased odds of healthcare avoidance (AOR = 1.32, 95% CI = 1.21–1.45) relative to transgender women. Living in poverty (AOR = 1.52, 95% CI = 1.40–1.65) and visual non-conformity (AOR = 1.48, 95% CI = 1.33–1.66) were significant risk factors. Having health insurance (AOR = 0.87, 95% CI = 0.79–0.96) and disclosure of transgender identity (AOR = 0.77, 95% CI = 0.68–0.87) were protective against healthcare avoidance. A significant interaction of gender identity/expression with health insurance was found; having health insurance moderated the association between gender identity/expression and healthcare avoidance. Providers should consider gender differences, socio-demographic, and transgender-specific factors to improve accessibility of services to transgender communities. A multi-level and multi-faceted approach should be used to create safe, trans-affirmative environments in health systems. Transgender people encounter barriers to healthcare access. Providers should consider transgender-specific factors to improve healthcare access. A multi-faceted approach should be used to create trans-affirmative health settings.
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Affiliation(s)
- Luisa Kcomt
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA
| | - Kevin M Gorey
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
| | - Betty Jo Barrett
- Women's and Gender Studies, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA.,Institute for Research on Women and Gender, University of Michigan, 1136 Lane Hall, 204 S. State Street, Ann Arbor, MI, 48109-1290, USA.,Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, USA
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Intersecting Experiences of Healthcare Denials Among Transgender and Nonbinary Patients. Am J Prev Med 2020; 58:506-513. [PMID: 32001054 DOI: 10.1016/j.amepre.2019.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Transgender and nonbinary individuals experience high levels of health disparities and are more likely to experience denials of health care than their cisgender (nontransgender) counterparts. There is a lack of evidence on how healthcare denials vary by gender identity and other intersecting identity characteristics in the transgender and nonbinary populations. METHODS Using data from the 2015 U.S. Trans Survey (n=27,715), multivariate logistic regressions were used to analyze (in 2019) the increased likelihood of experiencing denials of trans-related care and standard care across socioeconomic and identity characteristics among the transgender and nonbinary population, including race, age, educational attainment, disability, income, and gender identity. RESULTS Almost 8% of the participants had been denied trans-specific health care, and >3% had been refused general health care. Transgender (compared with nonbinary), older, biracial, or multiracial, and lower-income participants, as well as those with less than a high school diploma and those with disabilities, were significantly more likely to experience refusal of care in general or trans-specific healthcare settings. CONCLUSIONS There is a need for better training of healthcare providers to be inclusive and reduce denial rates of their transgender and nonbinary patients. However, it is also clear that current rates of denial must be considered through a whole-person lens, considering the experience of concurrent oppressed identities and recognizing the increased risk those with multiple marginalized identities experience in being denied needed health care.
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Kattari SK, Bakko M, Hecht HK, Kattari L. Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health 2020; 10:100525. [PMID: 31872041 PMCID: PMC6909214 DOI: 10.1016/j.ssmph.2019.100525] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 01/26/2023] Open
Abstract
Transgender and nonbinary patients have a wide array of experiences when attempting to access healthcare, including discrimination and having to educate providers about trans people. This study examines the mental health factors connected to transgender and nonbinary patients' experience with providers to determine the likelihood of transgender or nonbinary patients receiving respectful care after a provider knows about the patient's gender identity, and patients' experience of having to educate providers about trans people, controlling for sociodemographic factor. Using data from the 2015 United States Trans Survey (N = 27,715), chi-square tests of independence and multivariate logistic regressions were used to explore the odds of transgender or nonbinary individuals having a positive experience with a doctor or healthcare provider. Of the respondents, 24.31% experienced having to educate a provider about trans people when seeking care, and 62.90% experienced a provider knowing they were transgender or nonbinary and treating them with respect. Those experiencing depression and suicidal thoughts were significantly less likely to have had a provider treat them with respect, and significantly more likely to need to educate their providers. Gender, age, disability status, and educational level were significant across both variables; income was significant regarding having to educate a provider. Healthcare providers need ongoing training and education to improve their care of transgender and nonbinary patients, specifically around acknowledging the multiple backgrounds and experiences of such patients, including those related to mental health, gender, race, age, income, educational level, and disability.
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Affiliation(s)
- Shanna K. Kattari
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Matthew Bakko
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Hillary K. Hecht
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Leonardo Kattari
- Michigan State University School of Social Work, 655 Auditorium Road, East Lansing, MI, 48824, USA
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