Technology use to facilitate health care among young adult transgender women living with HIV

Transgender Individuals and Digital Health

PURPOSE OF REVIEW

The goal of this review is to assess the use of digital technologies to promote the health and well-being of transgender and gender diverse (TGD) people.

RECENT FINDINGS

TGD individuals experience numerous health disparities, including low uptake of HIV prevention strategies, such as pre-exposure prophylaxis, increased HIV incidence, and suboptimal HIV-related outcomes. These health disparities are the result of widespread intersectional stigma on the basis of gender identity, gender expression, socioeconomic class, race, and ethnicity, which negatively impact access to general medical and transgender-specific health care. TGD individuals often delay or avoid essential medical services due to fear of discrimination. Clinicians frequently lack training, competence, and skills in transgender medicine, further exacerbating the health disparities faced by TGD people. Digital technologies have been used to improve research and clinical care for TGD populations through various modalities; telemedicine, telehealth and mHealth. Digital health technologies, including HIT-enabled clinical decision support, telehealth, telemedicine, and mHealth, offer innovative ways to improve health care access, improve quality of care, and reduce health disparities for TGD populations, including and beyond HIV outcomes, through enhanced care delivery, clinician education, and enhancing social support networks.

Information and communication technology-based health interventions for transgender people: A scoping review

In the recent past, there has been a strong interest in the use of information and communication technology (ICT) to deliver healthcare to 'hard-to-reach' populations. This scoping review aims to explore the types of ICT-based health interventions for transgender people, and the concerns on using these interventions and ways to address these concerns. Guided by the scoping review frameworks offered by Arksey & O'Malley and the PRISMA-ScR checklist, literature search was conducted in May 2021 and January 2022 in three databases (PubMed, CINAHL and Scopus). The two searches yielded a total of 889 non-duplicated articles, with 47 of them meeting the inclusion criteria. The 47 articles described 39 unique health projects/programs, covering 8 types of ICT-based interventions: videoconferencing, smartphone applications, messaging, e-coaching, self-learning platforms, telephone, social media, and e-consultation platforms. Over 80% of the health projects identified were conducted in North America, and 62% focused on HIV/sexual health. The findings of this review suggest that transgender people had often been regarded as a small subsample in ICT-based health projects that target other population groups (such as 'men who have sex with men' or 'sexual minority'). Many projects did not indicate whether transgender people were included in the development or evaluation of the project. Relatively little is known about the implementation of ICT-based trans health interventions outside the context of HIV/sexual health, in resource limiting settings, and among transgender people of Asian, Indigenous or other non-White/Black/Hispanic backgrounds. While the range of interventions identified demonstrate the huge potentials of ICT to improve healthcare access for transgender people, the current body of literature is still far from adequate for making comprehensive recommendations on the best practice of ICT-based interventions for transgender people. Future ICT-based interventions need to be more inclusive and specified, in order to ensure the interventions are safe, accessible and effective for transgender people.

Characteristics of the health information seeking behavior of LGBTQ+ individuals: a systematic review on information types, information sources and influencing factors

Purpose

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) individuals' health information seeking is an important topic across multiple disciplines and areas. The aim of this systematic review is to create a holistic view of sexual and gender minority individuals' health information seeking reported in multidisciplinary studies, with regard to the types of health information LGBTQ+ individuals sought and information sources they used, as well as the factors influencing their health information seeking behavior.

Design/methodology/approach

The review is based on the literature search in 10 major academic databases. A set of inclusion and exclusion criteria was applied to identify studies that provide evidence on LGBTQ+ individuals' health information seeking behavior. The studies were first screened by title and abstract to determine whether they met the inclusion criteria. The full texts of each relevant study were obtained to confirm whether the exclusion criteria were met. The reference lists of the included studies were manually scanned. The relevant information was then extracted from selected articles and analyzed using thematic content analysis.

Findings

A seed set of 3,122 articles published between 1997 and 2020 was evaluated, and 46 total articles were considered for further analysis. The review results show that two major categories of health information sought by LGBTQ+ individuals were sexual and nonsexual, which were further classified into 17 specific types. In terms of health information sources, researchers have reported that online resources, interpersonal sources and traditional media were frequently used. Moreover, 25 factors affecting LGBTQ+ individuals' health information seeking were identified from the literature.

Originality/value

Through evidence-based understanding, this review preliminarily bridged the knowledge gap in understanding the status quo of studies on LGBTQ+ individuals' health information seeking and proposed the potential research directions that information science researchers could contribute to this important area.

mHealth for transgender and gender-expansive youth: harnessing gender-affirmative cross-disciplinary innovations to advance HIV prevention and care interventions

Transgender and gender-expansive (TGE) youth endure stark disparities in health and wellbeing compared to their cisgender peers. A key social determinant of health for TGE adolescents and emerging adults is gender affirmation, which encompasses multidimensional validations of an individual's lived gender. Lacking available resources for one's gender affirmation, TGE young people may engage in high-risk maladaptive coping behaviors, linked to their disproportionately high HIV-acquisition risk. A range of innovative mobile technologies are guided by the Gender-Affirmative Framework to promote the health of TGE communities, including through HIV prevention and care continuum outcomes. The aim of this review was to examine key features of existing mobile technologies that can be leveraged to advance the field of TGE-responsive mHealth. We systematically searched scientific records, gray literature, and the iOS and Android app distribution services. To be eligible, platforms and interventions needed to be tailored exclusively to a TGE user base, incorporate gender-affirming features, and be optimized for or adaptive to mobile technologies. Eligible interventions (N=24) were compared on evidence of utility, core functionalities, and dimensions of gender affirmation. Smartphone applications (apps) and webapps (n=16) were the most common delivery modality. Many interventions (n=9) aimed to address HIV-related outcomes and integrated gender-affirmative features. The most common gender-affirmative features originated in fields of human-computer interactions and informatics, or were crowdfunded by TGE developers. HIV-focused interventions incorporated evidence-based health behavior change strategies and utilized rigorous evaluation methods. Across modalities and disciplines, behavioral self-monitoring and access to HIV prevention services were the most frequent features. Over two-thirds of the interventions reviewed aimed to provide medical gender affirmation (e.g, provided guidance on obtaining medically sanctioned hormone therapies, or safely practicing non-medical options such as chest-binding) or psychological gender affirmation (e.g, provided linkage to mental health counseling). Our results show that mHealth and other technology-mediated interventions offer a diverse range of both evidence-based and innovative features; however, many have not been rigorously evaluated in a randomized controlled trial to support TGE users. A continuing commitment to evidence-based health behavior change strategies, exemplified by the HIV-focused interventions included in this review, is essential to advancing gender-affirmative mHealth. The unique and highly innovative features of platforms originating outside the fields of HIV prevention and care suggest new directions for TGE-responsive mHealth, and the need for more conscientious models of knowledge exchange with investigators across scientific disciplines, private-sector developers, and potential users.