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González-Mendiondo L, Mayor A, Moyano N. The Role of Healthcare Professionals in the Transition Process: A Qualitative Study of Families of Trans Children and Adolescents. Healthcare (Basel) 2024; 12:974. [PMID: 38786386 PMCID: PMC11121463 DOI: 10.3390/healthcare12100974] [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: 02/06/2024] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
The aim of this study was to explore the role that healthcare professionals, such as pediatricians, psychologists, psychiatrists and sexologists, play in supporting trans children and adolescents in their transition processes. To this end, 22 life stories written by parents of trans children and adolescents who had undergone social transition were collected, and a qualitative analysis was carried out using MAXQDA software. For this purpose, three key periods were considered in the stories: before, during and after the transition. Among other aspects, the stories highlight a major lack of understanding on the part of the professionals who should support trans children and adolescents, and their families, in their transition processes. Parents described the attitude of those professionals who actively listened to their children's needs and were cooperative as positive, even if they do not have the necessary training. The need for specific training in diversity is one of the main conclusions of this study.
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Affiliation(s)
| | - Aingeru Mayor
- Departamento de e Lenguajes y Sistemas Informáticos, Universidad del País Vasco, 48940 San Sebastián, Spain;
| | - Nieves Moyano
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Jaén, 23071 Jaén, Spain
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Raghuram H, Parakh S, Tugnawat D, Singh S, Shaikh A, Bhan A. Experiences of transgender persons in accessing routine healthcare services in India: Findings from a participatory qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002933. [PMID: 38422163 PMCID: PMC10903866 DOI: 10.1371/journal.pgph.0002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
Despite having a higher burden of health problems, transgender persons face challenges in accessing healthcare in India. Most studies on healthcare access of transgender persons in India focus only on HIV related care, mental healthcare, gender affirmative services or on the ethno-cultural communities or transgender women. This study fills this gap by focusing on diverse gender identities within the transgender community with a specific focus on experiences in accessing general or routine healthcare services. A qualitative descriptive approach was used in this study. 23 in-depth interviews and 6 focus group discussions were conducted virtually and in-person with a total of 63 transgender persons in different regions of India between May and September 2021. The study used a community-based participatory research approach and was informed by the intersectionality approach. Thematic analysis was conducted to analyze the data. Four key themes emerged: (i) intersectional challenges in accessing healthcare start outside of the health system, continue through cisgender-binary-normative health systems that exclude transgender persons; and at the interface with individuals such as health professionals, support staff and bystanders; (ii) the experiences negatively impact transgender persons at an individual level; (iii) in response, transgender persons navigate these challenges across each of the levels: individual, health system level and from outside of the health system. This is a first of its kind qualitative participatory study focusing on routine healthcare services of transgender persons in India. The findings indicate the need to move conversations on trans-inclusion in healthcare from HIV and gender affirmative services to routine comprehensive healthcare services considering the higher burden of health problems in the community and the impact of poor access on their lives and well-being.
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Affiliation(s)
- Harikeerthan Raghuram
- Initiative for Health Equity Advocacy and Research (iHEAR), Bhopal, India
- Sangath, Bhopal, India
| | - Sana Parakh
- Initiative for Health Equity Advocacy and Research (iHEAR), Bhopal, India
- Sangath, Bhopal, India
| | - Deepak Tugnawat
- Initiative for Health Equity Advocacy and Research (iHEAR), Bhopal, India
- Sangath, Bhopal, India
| | - Satendra Singh
- Initiative for Health Equity Advocacy and Research (iHEAR), Bhopal, India
- Department of Physiology, University College of Medical Sciences, Delhi, India
| | - Aqsa Shaikh
- Initiative for Health Equity Advocacy and Research (iHEAR), Bhopal, India
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Anant Bhan
- Initiative for Health Equity Advocacy and Research (iHEAR), Bhopal, India
- Sangath, Bhopal, India
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Tyrie D, Oliva A, Llorin H, Zayhowski K. Transgender and gender diverse individuals' perspectives on discussions of fetal sex chromosomes in obstetrics care. J Genet Couns 2024. [PMID: 38198055 DOI: 10.1002/jgc4.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/26/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Abstract
In the past decade, prenatal cell-free DNA screening (cfDNA) has become ubiquitous as a screening tool for fetal aneuploidy and sex chromosomes. Healthcare provider (HCP) discussions and public perceptions of sex and gender uniquely impact transgender and gender diverse (TGD) individuals, and existing cfDNA guidelines lack recommendations regarding how to discuss sex and gender prenatally. The aim of this exploratory qualitative study was to examine TGD individuals' opinions regarding fetal sex chromosome disclosure sessions. Twelve semi-structured virtual interviews were conducted with TGD individuals regarding their perspectives on the discussion of fetal sex chromosomes by HCPs within the prenatal setting. Interviews were coded and analyzed using a reflexive thematic approach, generating four major themes: (1) Current practices in prenatal care exclude gender diverse people; (2) HCPs' responsibility to de-gender discussions of sex chromosomes in prenatal care; (3) HCPs' responsibility to acknowledge gender diversity; and (4) HCPs' influence on societal perceptions of sex and gender. More guidance is needed from professional societies regarding best practices for HCP discussions of sex chromosomes, sex, and gender. Participants recommended HCPs educate patients about sex chromosomes and their relevance to health while avoiding the conflation of sex and gender terms. Additionally, there is an acute need for trans-inclusive prenatal healthcare. Ultimately, HCPs' and organizations are in a prime position to deconstruct rigid gender binaries and promote societal inclusion of TGD people.
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Affiliation(s)
- Dana Tyrie
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, New York, USA
| | - Alejandra Oliva
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, New York, USA
| | | | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
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Neiman T, Sieve L, Stenberg L, Molesky N, Nic Rider G. "Bridging the Gap": School Nurse Experiences Providing Care for Transgender and Gender Diverse Students and Their Parents/Guardians. J Sch Nurs 2023; 39:377-384. [PMID: 34160304 DOI: 10.1177/10598405211025442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
School systems are often not set up to support transgender and gender diverse (TGD) students, which results in unsafe and unsupportive environments and other institutional barriers to helping TGD students thrive. An important factor to students' feeling safe and supported in schools may be their relationship with school nurses. The purpose of this study was to describe school nurses' experiences working with TGD students and their parents/guardians, their role in working with this community, and the challenges nurses face when trying to serve TGD students. Semistructured interviews were conducted with 23 school nurses across a Midwestern state. Thematic analysis was used to identify themes: gender-affirming education and interpersonal collaboration, bridging the gap between TGD youth and parents/guardians, gender-affirming care and confidentiality, and navigating parental acceptance and gender-affirmation. School nurses expressed a strong desire to support TGD students but lack the structure and training within schools.
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Affiliation(s)
- Tammy Neiman
- School of Nursing, College of Allied Health and Nursing, Minnesota State University, Mankato, MN, USA
| | - Laurie Sieve
- Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN, USA
| | - Louise Stenberg
- Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN, USA
| | | | - G Nic Rider
- Institute for Sexual and Gender Health, National Center for Gender Spectrum Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Kantor LZ, Tordoff DM, Haley SG, Crouch JM, Ahrens KR. Gender and Sexual Health-Related Knowledge Gaps and Educational Needs of Parents of Transgender and Non-Binary Youth. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-023-02611-9. [PMID: 37233838 DOI: 10.1007/s10508-023-02611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/26/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
Parents can have a substantial impact on adolescent sexual decision-making, but few studies have explored the role of parents in providing sexual health information to transgender and non-binary (TNB) youth, a population that experiences significant sexual and mental health disparities and lower levels of perceived family support compared with other youth. This study aimed to elucidate existing knowledge gaps and content deemed important for a sexual health curriculum and educational materials for parents of TNB youth. We conducted 21 qualitative interviews with five parents of TNB youth, 11 TNB youth aged 18+, and five healthcare affiliates to identify parents' educational needs. We analyzed the data using theoretical thematic analysis and consensus coding. Parents self-reported multiple knowledge deficits regarding gender/sexual health for TNB individuals and were primarily concerned with long-term impacts of medical interventions. Youth goals for parents included greater understanding of gender/sexuality and sufficient knowledge to support youth through social transition to their affirmed gender identity. Content areas suggested for a future curriculum for parents of TNB youth included: basics of gender/sexuality, diverse narratives of TNB experiences/identities, gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, and resources for peer support. Parents desired access to accurate information and wanted to feel equipped to facilitate affirming conversations with their child, something that could combat health disparities among TNB youth. An educational curriculum for parents has the potential to provide a trusted information source, expose parents to positive representations of TNB individuals, and help parents support their TNB child through decisions about potential gender-affirming interventions.
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Affiliation(s)
- Lane Z Kantor
- David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA, 90095, USA.
| | - Diana M Tordoff
- Department of Epidemiology, Stanford University School of Medicine Palo Alto, Stanford, CA, USA
| | | | - Julia M Crouch
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kym R Ahrens
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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Tyler TR, Huddleston BS, Barton TN, Thornton MH, Calloway ET, Martin KG, Morgan AL, Munoz V. Qualitative metasummary: Parents seeking support related to their TGNC children. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:132-148. [PMID: 37114113 PMCID: PMC10128398 DOI: 10.1080/26895269.2022.2068724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Background: Parents seek support on behalf of their transgender and gender nonconforming (TGNC) children. Previous qualitative studies explore the types of support parents seek inside and outside of healthcare settings. Healthcare providers often remain unprepared to effectively provide gender-affirming services to TGNC children and their accompanying parents and may benefit from learning about the support seeking experiences of parents with TGNC children. Aims: This paper summarized qualitative research studies that address the topic of parents seeking support on behalf of their TGNC children. We produced this report for healthcare providers to review to enhance gender-affirming services for parents and TGNC children. Methods: This paper outlines a qualitative metasummary of studies from the United States or Canada with data collected from parents of TGNC children. Data collection included the steps of journal runs, database searches, reference checks, and area scans. Data analysis involved the steps of extracting, editing, grouping, abstracting, and calculating the intensity and frequency effect sizes for finding statements from qualitative research study articles. Results: The results of this metasummary yielded two primary themes, six subthemes, and 24 total findings. The first primary theme of seeking guidance had three subthemes: educational resources, community networks, and advocacy efforts. The second primary theme of seeking healthcare had three subthemes: healthcare providers, mental healthcare, and general healthcare. Discussion: These findings provide information healthcare providers can use to inform their practice. These findings also highlight the importance of providers working collaboratively with parents when serving TGNC children. This article concludes with practical tips for providers.
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Affiliation(s)
- Tee R. Tyler
- Texas Christian University, Fort Worth, Texas, USA
- CONTACT Tee R. Tyler Texas Christian University, TCU Box 298750, Fort Worth, TX76129, USA
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Bosse JD, Dion KA, Campbell Galman S, Chiodo LM. Transgender and nonbinary young adults' perception of sibling and parental support for gender identity. Res Nurs Health 2022; 45:569-579. [DOI: 10.1002/nur.22251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/10/2022] [Accepted: 06/12/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jordon D. Bosse
- School of Nursing Northeastern University Boston Massachusetts USA
- External Faculty Nurse Scientist Massachusetts General Hospital Boston Massachusetts USA
| | - Kimberly A. Dion
- Elaine Marieb College of Nursing University of Massachusetts Amherst Massachusetts USA
| | - Sally Campbell Galman
- Child and Family Studies, College of Education University of Massachusetts Amherst Massachusetts USA
| | - Lisa M. Chiodo
- Elaine Marieb College of Nursing University of Massachusetts Amherst Massachusetts USA
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Lorusso M, Albanesi C. When the context rows against. Voicing parents of transgender children and teenagers in Italy: A qualitative study. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Maric Lorusso
- Department of Psychology, Campus Cesena, Alma Mater Studiorum University of Bologna Bologna Italy
| | - Cinzia Albanesi
- Department of Psychology, Campus Cesena, Alma Mater Studiorum University of Bologna Bologna Italy
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Lelutiu-Weinberger C, English D, Sandanapitchai P. The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US. Behav Med 2020; 46:175-188. [PMID: 32787726 PMCID: PMC8094222 DOI: 10.1080/08964289.2020.1725414] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.
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Affiliation(s)
- Corina Lelutiu-Weinberger
- Rutgers Biomedical and Health Sciences, School of Nursing, François-Xavier Bagnoud Center, Rutgers, The State University of New Jersey
| | - Devin English
- Rutgers Biomedical and Health Sciences, School of Public Health, Rutgers, The State University of New Jersey
| | - Priyadharshiny Sandanapitchai
- Rutgers Biomedical and Health Sciences, School of Nursing, François-Xavier Bagnoud Center, Rutgers, The State University of New Jersey
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Thomas SP. Progress Regarding Transgender Issues? Issues Ment Health Nurs 2019; 40:735-736. [PMID: 31430207 DOI: 10.1080/01612840.2019.1640040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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