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Kasson E, Szlyk HS, Li X, Constantino-Pettit A, Smith AC, Vázquez MM, Wilfley DE, Taylor CB, Fitzsimmons-Craft EE, Cavazos-Rehg P. Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches. Int J Eat Disord 2024; 57:1518-1531. [PMID: 38445416 PMCID: PMC11262972 DOI: 10.1002/eat.24186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. METHOD Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). RESULTS Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). DISCUSSION Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. PUBLIC SIGNIFICANCE This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arielle C Smith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa M Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Nicoletti A, Giuliano L, Donzuso G, Cicero CE. Exploring the knowledge, attitudes, and practices on sexual and gender minorities patients: a survey on Italian Neurologists. Neurol Sci 2024; 45:1465-1470. [PMID: 37947982 DOI: 10.1007/s10072-023-07181-1] [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: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Sexual and gender minorities (SGM) encompass individuals identifying as lesbian, gay, bisexual, transgender, and queer (LGBTQ). SGM patients experience difficulties in accessing healthcare and may face discrimination, impacting their overall health outcomes. Enhancing healthcare professionals' knowledge is the initial step in dismantling these barriers. MATERIALS AND METHODS The study has been conducted on the neurologists of the Italian Society of Neurology (SIN). We utilized a survey instrument comprising 24 Likert-type questions to investigate knowledge, attitudes, and practices concerning sexual orientation and gender identity minorities. Likert scales were assessed with scores 1 and 2 as negative response, 3 as neutral, and 4 and 5 as positive responses. RESULTS A total of 177 neurologists (103 women; 58.2%) participated, with a mean age of 44.3 ± 14.6 years answered the survey. Over half recognized sexual and gender orientation as social determinants of health, yet only a minority acknowledged the elevated prevalence of physical and mental health issues in SGM populations. Nearly, all respondents felt confident in examining a sexual minority patient, while only half felt the same regarding transgender patients. The majority of neurologists expressed a need for more comprehensive training and supervision in treating SGM patients. CONCLUSION To enhance healthcare quality for SGM populations, healthcare professionals must receive appropriate training in how to approach, assess, and treat patients within this demographic.
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Affiliation(s)
- Alessandra Nicoletti
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
| | - Loretta Giuliano
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Giulia Donzuso
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
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Ryan Schultz T. Clinicians signal the need to improve competency in the care of patients who identify as LGBTQ. Evid Based Nurs 2024; 27:59. [PMID: 37657888 DOI: 10.1136/ebnurs-2023-103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Theresa Ryan Schultz
- Division of Emergency Medicine and Trauma and Division of Nursing, Children's National Hospital, Washington, DC, USA
- The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
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Tarantino MR, Wesche R. Queering Cisgender LGB+ Women's Sexual Health Scripts. JOURNAL OF SEX RESEARCH 2024:1-13. [PMID: 38446103 DOI: 10.1080/00224499.2024.2323742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The invisibility of lesbian, gay, and bisexual (LGB+) women in sexual health research is of particular concern when it comes to understanding and supporting their sexual health practices. We conducted a qualitative secondary analysis of sexual health decision-making interviews among 22 LGB+ cisgender women who ranged in age from 20 to 26 (M = 23.1 years, SD = 1.8 years). Participants were mostly bisexual (n = 9), White (n = 13), and all reported at least some college education. Results showed that LGB+ women both reify and push against heteronormativity in their sexual partnerships. By queering definitions of "sex" beyond heterosexual intercourse, leaning into trust as a foundation of new sexual partnerships, and promoting accessible and realistic hygienic strategies for STI prevention, LGB+ women queer, or reimagine, new sexual scripts. These results highlight the need for relationship and sexual health scholars to direct focus toward the promotion of holistic sexual and relationship education and research which reflects LGB+ women's various sexual desires, goals and needs. Understanding LGB+ women's sexual scripts and health outcomes will ensure that this population continues to be validated and supported by clinicians, researchers, and educators.
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Affiliation(s)
- Mari R Tarantino
- Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Rose Wesche
- Human Development and Family Science, Virginia Polytechnic Institute and State University
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Buckingham P, Bourne A, McNair R, Hill AO, Lyons A, Carman M, Amos N. The influence of care continuity and disclosure of sexual orientation in general practice on lesbian, bi+ and queer cisgender women's engagement with mental health services. Aust J Prim Health 2024; 30:NULL. [PMID: 37574262 DOI: 10.1071/py23001] [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: 01/06/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lesbian, bisexual+ and queer (LBQ+) cisgender women have considerable unmet mental health needs. The aims of this study were to examine LBQ+ cisgender women's prior engagement with general practitioners (GPs), and how this relationship shaped their mental health service use. METHOD Data from 2707 cisgender LBQ+ women were drawn from a national survey of adults who are lesbian, gay, bisexual, trans, intersex, queer or questioning, asexual and other diverse sexuality and gender identities (LGBTIQA+) in Australia. Multivariable logistic regression analyses examined demographic predictors of continuity of care with GPs and GPs' awareness of LBQ+ women's sexual orientation. The relationship between these variables and recent mental health service use was then analysed, comparing LBQ+ women's engagement with services known to be LGBTIQA+ inclusive and those without an inclusive reputation. RESULTS LBQ+ cisgender women with a regular GP had greater odds of having accessed mental health services in the last 12months. Two-thirds had a regular GP, with the lowest odds among women aged 18-35years and highest odds among women with a disability. LBQ+ women who did not believe their regular GP knew of their sexuality had lower odds of having accessed LGBTIQA+ inclusive mental health services. These individuals were typically aged below 25years, bisexual+ or queer identified, had below undergraduate-level education, earned <$2000 AUD per week, or lived in an outer-suburban or regional area. CONCLUSION GPs may be missing opportunities to promote continuity of care through developing trusting relationships with specific sub-populations of LBQ+ women, which in turn appears to sustain inequitable access to mental health care. To offer appropriate care and referrals for this population, GPs should provide safe and inclusive environments to enable comfortable and supportive discussions about sexual orientation when this is relevant to a person's health care.
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Affiliation(s)
- Pip Buckingham
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia; and Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia; and Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia; and Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
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Saadat M, Keramat A, Jahanfar S, Nazari AM, Ranjbar H, Motaghi Z. Barriers and Facilitators to Accessing Sexual and Reproductive Health Services Among Transgender People: A Meta-Synthesis. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:40-51. [PMID: 37470127 DOI: 10.1177/27551938231187863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The availability and accessibility of sexual and reproductive health (SRH) services for transgender individuals are crucial. This population is deprived of health care due to rejection, stigma, gender-based discrimination, confidentiality, and violence. This review attempts to provide readers with an account of the fundamental problems that the transgender population faces regarding experiences of SRH. This meta-synthesis review applied the Social-Ecological Model (SEM) to address trans individuals' SRH factors. The databases were searched using "SRH" and "transgender" keywords. Fifty studies were finally selected. All studies were qualitative, including 36 semi-structured/ in-depth interviews, two focus group studies, and 12 interviews and focus group studies. The Social-Ecological Model application illustrates the impact of individual, interpersonal, institutional, and social factors on the condition of SRH among transgender individuals. This meta-synthesis reinforces multiple levels of factors that influence the SRH of transgender individuals. These include limited information, lack of awareness, low socioeconomic status, stigma and discrimination, and social deprivation. Interventions are urgently needed to provide better sexual and reproductive well-being for transgender individuals.
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Affiliation(s)
- Mina Saadat
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shayesteh Jahanfar
- Tufts School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA
| | - Ali Mohammad Nazari
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Motaghi
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Komlenac N, Langmann F, Hochleitner M. Explorative Questionnaire Study About Education with Regard to the Health of Sexual Minorities at an Austrian Medical University. JOURNAL OF HOMOSEXUALITY 2023; 70:2955-2977. [PMID: 35700380 DOI: 10.1080/00918369.2022.2085937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Physicians can play a critical role in helping lesbian, gay, and bisexual-identified (LGB) individuals face minority stress. The current questionnaire study among 305 medical students (62.6% women/37.4% men; Mage = 23.4, SD = 3.2) assessed whether medical students learn about LGB-specific concepts at an Austrian medical university. Students reported that their education contained little content about LGB-specific concepts. The majority of students did not hold negative attitudes toward homosexuality and they would like a larger range of courses concerning LGB-specific topics. The barrier most strongly associated with the intention to ask future patients about their sexual orientation was the belief that sexual orientation was irrelevant for clinical practice. Future education programs on LGB-specific topics may not need to focus on reducing negative attitudes toward sexual minorities, but should contain more facts on LGB individuals' specific healthcare needs and explain to students why a patient's sexual orientation is important to healthcare.
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Affiliation(s)
- Nikola Komlenac
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Flora Langmann
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria
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Mitchell LA, Jacobs C, McEwen A. (In)visibility of LGBTQIA+ people and relationships in healthcare: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107828. [PMID: 37301011 DOI: 10.1016/j.pec.2023.107828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/16/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify and map research into the visibility of LGBTQIA+ people and their relationships in healthcare, with the view to inform future research and practice. METHOD Five databases were systematically searched for published and grey literature. Primary research reporting on visibility of LGBTQIA+ people in healthcare was included. Two reviewers independently screened the studies until an acceptable level of agreement was reached. A narrative synthesis was conducted and findings mapped to a taxonomy of microaggressions involving three sub-categories: microinsults, microassaults and microinvalidations. RESULTS The microaggressions identified included Microinsults: 'Perception of health professionals' knowledge and comfort' and 'Disclosure'; Microassaults: 'Discrimination and stigma'; Microvalidations: 'Accessing and navigating through services', 'Encounters of assumptions and stereotypes', 'Validating identities and including relationships', and 'Reading the environment'. CONCLUSION Despite growing societal acceptance, microaggressions still exist within healthcare. Groups within LGBTQIA+ communities have varying levels of visibility in research and healthcare based on the studies included. PRACTICE IMPLICATIONS The limited visibility of LGBT and lack of visibility of QIA+ people and their relationships in healthcare highlight the need to include the views of all LGBTQIA+ communities in research, and to ensure health professionals and clinical services are equipped to address this (in)visibility gap.
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Affiliation(s)
- Lucas A Mitchell
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia; Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Australia.
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Kelleher ST, Barrett MJ, Durnin S, Fitzpatrick P, Higgin A, Hall D. Staff competence in caring for LGBTQ+ patients in the paediatric emergency department. Arch Dis Child 2023:archdischild-2022-325151. [PMID: 37094883 DOI: 10.1136/archdischild-2022-325151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/24/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE This study aimed to assess the competency of paediatric emergency department (PED) multidisciplinary staff in caring for LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, + inclusive of all identities) adolescents. DESIGN This was an observational study within which participants were required to complete the LGBT-Development of Clinical Skills Scale self-assessment tool of clinical competence. SETTING It was conducted across three PEDs and one urgent care centre pertaining to the Children's Health Ireland healthcare group. PARTICIPANTS Doctors, nurses and healthcare workers were eligible to participate. EXCLUSION CRITERIA non-front facing staff; prior completion of an eLearning module intended to serve as a future educational intervention. MAIN OUTCOME MEASURES Participants were assessed on: (1) attitudinal awareness towards LGBTQ+ individuals; (2) knowledge of LGBTQ+ health issues and (3) clinical preparedness in caring for LGBTQ+ patients. Each domain is scored out of a maximum of 7 points. RESULTS 71 eligible participants completed the study. 40/71 (56%) were doctors, and 31/71 (44%) were nurses. The mean score for attitudinal awareness was 6.54/7 (SD 0.59), indicating overall positive attitudes. The mean score for knowledge was lower (5.34/7, SD 1.03) and lowest for clinical preparedness (3.39/7, SD 0.94). Participants were less confident in caring for transgender than LGB patients and scored very low when asked if they had received adequate training in caring for transgender young people (2.11/7). CONCLUSIONS This study demonstrates positive attitudes towards LGBTQ+ patients among PED staff. However, there was a gap in knowledge and clinical preparedness. Increased training in caring for LGBTQ+ young people is necessary.
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Affiliation(s)
| | - Michael J Barrett
- Department of Paediatric Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Women's and Children's Health, University College Dublin, Dublin, Ireland
| | - Sheena Durnin
- Department of Paediatric Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Discipline of Paediatrics, Trinity College Dublin, Dublin, Ireland
| | - Patrick Fitzpatrick
- Department of Paediatric Emergency Medicine, Children's Health Ireland, Dublin, Ireland
| | - Agnes Higgin
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Dani Hall
- Department of Paediatric Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Women's and Children's Health, University College Dublin, Dublin, Ireland
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
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Marjadi B, Flavel J, Baker K, Glenister K, Morns M, Triantafyllou M, Strauss P, Wolff B, Procter AM, Mengesha Z, Walsberger S, Qiao X, Gardiner PA. Twelve Tips for Inclusive Practice in Healthcare Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4657. [PMID: 36901666 PMCID: PMC10002390 DOI: 10.3390/ijerph20054657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association's diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.
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Affiliation(s)
- Brahmaputra Marjadi
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Joanne Flavel
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Stretton Health Equity, Stretton Institute, School of Social Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Kirsten Baker
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Australian Research Consortium in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Kristen Glenister
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Department of Rural Health, The University of Melbourne, Wangaratta, VIC 3677, Australia
| | - Melissa Morns
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Mel Triantafyllou
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia
| | - Penelope Strauss
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6009, Australia
| | - Brittany Wolff
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Psychological Sciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Alexandra Marie Procter
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Zelalem Mengesha
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Centre for Primary Health Care and Equity, The University of New South Wales, UNSW, Sydney, NSW 2025, Australia
| | - Scott Walsberger
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- ACON, Surry Hills, NSW 2010, Australia
| | - Xiaoxi Qiao
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Paul A. Gardiner
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
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Ropero-Padilla C, Rodríguez-Valbuena C, Rodriguez-Arrastia M, Ruiz-Fernández MD, Roman P, Sanchez-Labraca N. Exploring the microaggression experiences of LGBTQ+ community for a culturally safe care: A descriptive qualitative study. NURSE EDUCATION TODAY 2022; 115:105423. [PMID: 35661578 DOI: 10.1016/j.nedt.2022.105423] [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: 11/30/2021] [Revised: 05/03/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Microaggressions, stigma and minority stress still occur among sexual and gender minorities on an individual, interpersonal, and structural level. Cultural immersion may therefore be an effective strategy in order to find potential healthcare approaches and foster more comprehensive, critical, intersectional, and inclusive care practices. OBJECTIVE The aim of this study was to develop insight into the experiences of LGBTQ+ community members to obtain in-depth perceptions of microaggressions and an understanding of their healthcare needs to provide a culturally safe and sensitive care. DESIGN A qualitative descriptive study was conducted between September to November 2021. SETTINGS This study was conducted at the University of Almeria with LGBTQ+ community members. PARTICIPANTS Twenty-one LGBTQ+ individual participated in this study, aged between 18 and 56 years old. METHODS Participants were recruited using a purposive sampling. Responses from semi-structured interviews were studied using a thematic analysis. Methods and findings are reported in line with Standards for Reporting Qualitative Research recommendations. RESULTS Three themes emerged from the qualitative analysis: (i) experiences to understand the impact of a heteronormative society, (ii) perceptions of engaging with health education and promotion, and (iii) healthcare access, use and experiences within the LGTBQ+ community. CONCLUSIONS This study yields findings about the difficulties that LGBTQ+ community members face in the healthcare system in order to ensure equal care for vulnerable communities and integrate a culturally safe care approach into nursing practice. Certain microaffirmation strategies against social determinants of health such as school-based nursing strategies can help to raise awareness and knowledge among heterosexual peers and reduce cultural invisibility, microaggressions, stigma and minority stress. In order to provide culturally safe care, educators might also explore the inclusion of gender and sexual minority care content in both in-faculty education and ongoing continuing education for nurse practitioners.
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Affiliation(s)
- Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain.
| | - Cristian Rodríguez-Valbuena
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.
| | - Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain.
| | - María Dolores Ruiz-Fernández
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain; Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.
| | - Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain; Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.
| | - Nuria Sanchez-Labraca
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain.
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Joy P, Thomas A, Aston M. Compassionate Discourses: A Qualitative Study Exploring How Compassion Can Transform Healthcare for 2SLGBTQ+ People. QUALITATIVE HEALTH RESEARCH 2022; 32:1514-1526. [PMID: 35739090 PMCID: PMC9411689 DOI: 10.1177/10497323221110701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Compassion can be seen as a necessary, but often lacking, concept and practice in healthcare. Due to the cis-heteronormative nature of societies, people who identify as Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) often experience health disparities and disparities in accessing compassionate healthcare. We aimed to explore the meanings of compassion in healthcare for Canadian 2SLGBTQ+ people. Using a poststructuralist framework, 20 self-identifying 2SLGBTQ+ participants were interviewed. Data was analyzed through discourse analysis. Three main discursive considerations are discussed, including (1) meanings and expectations of compassion in healthcare, (2) compassionate healthcare is not guaranteed, and (3) prescription for care: self-compassion for healing and health. The results provide insights into how compassionate healthcare is framed for 2SLGBTQ+ participants and how compassion is often lacking for them due to discourses of cis-heteronormativity and healthism.
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Affiliation(s)
- Phillip Joy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Andrew Thomas
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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MacKinnon KR, Kia H, Salway T, Ashley F, Lacombe-Duncan A, Abramovich A, Enxuga G, Ross LE. Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments. JAMA Netw Open 2022; 5:e2224717. [PMID: 35877120 PMCID: PMC9315415 DOI: 10.1001/jamanetworkopen.2022.24717] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition. OBJECTIVE To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice. DESIGN, SETTING, AND PARTICIPANTS Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. MAIN OUTCOMES AND MEASURES In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. RESULTS Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs. CONCLUSIONS AND RELEVANCE This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | | | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Enxuga
- School of Social Work, McGill University, Montreal, Québec, Canada
| | - Lori E. Ross
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Bunting SR, Calabrese SK, Spigner ST, Goetz TG, Morrison SD, Zucker SM, Ritchie TD, Garber SS, Batteson TJ. Evaluating Medical Students' Views of the Complexity of Sexual Minority Patients and Implications for Care. LGBT Health 2022; 9:348-358. [DOI: 10.1089/lgbt.2021.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samuel R. Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Sabina T. Spigner
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Teddy G. Goetz
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, USA
| | - Shane D. Morrison
- Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shana M. Zucker
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Timothy D. Ritchie
- Department of Psychology, Saint Xavier University, Chicago, Illinois, USA
| | - Sarah S. Garber
- Department of Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Tamzin J. Batteson
- DeWitt C. Baldwin Institute for Interprofessional Education, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Hill B, Dodd J, Uink B, Bonson D, Bennett S, Eades AM. Aboriginal and Queer Identity/ies in Western Australia: When There is a Need to Know in Therapeutic Settings. QUALITATIVE HEALTH RESEARCH 2022; 32:755-770. [PMID: 35201901 DOI: 10.1177/10497323211069682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A central question for the exploratory Aboriginal and LGBTQ+ researcher led project 'Breaking the Silence: Being Indigenous and identifying LGBTQ+' (Breaking the Silence) is how provision of genuinely inclusive service responses for Aboriginal and Torres Strait Islander people identifying as LGBTQ+ can be developed. This article presents the qualitative findings of this mixed-methods research project to show how organizational staff working in health, education and social support services in Western Australia consider the Aboriginal LGBTQ+ identity/experience. Analysis of the written, interview and focus group responses to a question about the relevance of LGBTQ+ identity show that these questions need to be considered and evaluated within diverse service cultures and philosophies of services. Staff views are diverse and organizational consensus on the relevance (or not) of LGBTQ+ identity needs to be the precursor before the development or consideration of changes to service delivery and models.
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Affiliation(s)
- Braden Hill
- Kurongkurl Katitjin Aboriginal Centre, 95980Edith Cowan University, Perth, WA, Australia
| | - Jennifer Dodd
- Kurongkurl Katitjin Aboriginal Centre, 95980Edith Cowan University, Perth, WA, Australia
| | - Bep Uink
- Kulbardi Aboriginal Centre, 5673Murdoch University, Perth, WA, Australia
| | | | - Sian Bennett
- Kurongkurl Katitjin Aboriginal Centre, 95980Edith Cowan University, Perth, WA, Australia
| | - Anne-Marie Eades
- Looking Forward Research Team, Faculty of Health Sciences, 1649Curtin University, Perth, WA, Australia
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16
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Birenbaum-Carmeli D, Inhorn MC, Patrizio P. Transgender men's fertility preservation: experiences, social support, and the quest for genetic parenthood. CULTURE, HEALTH & SEXUALITY 2021; 23:945-960. [PMID: 32484394 DOI: 10.1080/13691058.2020.1743881] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/13/2020] [Indexed: 05/25/2023]
Abstract
Transgender people assigned female at birth may undergo fertility preservation by egg or embryo freezing, usually prior to gender affirming treatment. In this binational ethnographic study, four transgender men were included as part of a larger comparative project on fertility preservation. In-depth ethnographic interviews allowed informants to talk freely about their fertility preservation experiences, and the circumstances that had enabled them to pursue this option. Prominent in men's accounts were the importance of genetic parenthood and the role of social support from others in the fertility preservation process. Indeed, in all cases, social support-from parents, siblings, partners, peers, physicians and employers-was critical, effectively enabling young transgender men to embark on their fertility preservation journeys and undergo the physically taxing process. This study illustrates the power of thriving through relationships that were critical in young transgender men's experiences of fertility preservation.
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Affiliation(s)
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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17
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Grant R, Smith AKJ, Newett L, Nash M, Turner R, Owen L. Tasmanian healthcare professionals' & students' capacity for LGBTI + inclusive care: A qualitative inquiry. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:957-966. [PMID: 32789892 DOI: 10.1111/hsc.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/14/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
The health disparities and care needs of lesbian, gay, bisexual, transgender and intersex (LGBTI+) patients are becoming well known. However, healthcare practitioners (HCPs) and medical students across the Global North report limited understanding of this population and express concern about their capacity to meet the needs of LGBTI + patients. To address these gaps in literature and practice, this study draws on qualitative interviews with 12 clinicians and five health professional students exploring their understandings and approaches to LGBTI + inclusive practice in Tasmania, Australia. Through a reflexive thematic analysis, we identified that both practicing clinicians and students did not believe that their training adequately prepared them to treat LGBTI + patients. Other key barriers included reduced awareness of LGBTI + community needs due to the lack of exposure to LGBTI + patients and unfamiliarity with appropriate referral pathways in the regional Tasmanian context. Conversely, factors enabling provision of LGBTI + inclusive care included prior experience working with LGBTI + patients and establishing a network of supportive colleagues and local services. Participants who identified as LGBTI + themselves saw their personal experiences as a strength in supporting LGBTI + patients. While awareness of LGBTI + inclusive health practice is increasing, Tasmanian practitioners report insufficient training and practical difficulties with referral as key challenges.
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Affiliation(s)
- Ruby Grant
- School of Social Sciences, University of Tasmania, Launceston, Tas., Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - Lyndsay Newett
- School of Social Sciences, University of Tasmania, Hobart, Tas., Australia
| | - Meredith Nash
- School of Social Sciences, University of Tasmania, Hobart, Tas., Australia
| | - Richard Turner
- School of Medicine, University of Tasmania, Hobart, Tas., Australia
| | - Louise Owen
- Sexual Health Service Tasmania, Hobart, Tas., Australia
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Prandelli M, Testoni I. Inside the doctor's office. Talking about intersex with Italian health professionals. CULTURE, HEALTH & SEXUALITY 2021; 23:484-499. [PMID: 32935650 DOI: 10.1080/13691058.2020.1805641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
This article explores how health professionals in Italy understand variations of sex characteristics (VSC), also referred to as intersex and/or disorders of sex development (DSD). With estimates of VSC frequency ranging from 0.018% to 1.7%, only a handful of highly specialised medical doctors are considered DSD experts. When addressing the daily health management of children and families who do not live near specialist DSD centres, these experts may refer individuals to the nearest health professional that Italian health services provides, opening up questions regarding how these professionals might act and react when faced with VSC. In this analysis of interview data from 65 Italian general practitioners, paediatricians and psychologists, we address two themes. The first theme discusses participants' previous experiences and case management, with a focus on social, medical and gender biases. The second theme examines health professionals' opinions and perspectives on ongoing conflicts concerning current best care practices. Our results highlight health professionals' cultural and gendered biases, confirming the need to develop specific professional training, guidelines and policies to improve the healthcare of people with VSC.
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Affiliation(s)
- Marta Prandelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy
| | - Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy
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19
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[Public funding of health research on LGTBIQ+population in Spain]. GACETA SANITARIA 2021; 36:106-110. [PMID: 33541782 DOI: 10.1016/j.gaceta.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the public funding of research on LGTBIQ+health in Spain. METHOD We conducted an observational and descriptive study. We sought research projects dealing with LGTBIQ+health funded by the research projects grant from the Instituto Carlos III from 2013 to 2019. We consulted the webpage and the FIS portal and we identified projects that included LGTB community, totally or partially. We estimated the absolute and relative frequencies of LGTBIQ+projects in relation to total funded projects; and we described the LGTBIQ+funded projects by year of funding, topics, LGTBIQ+subpopulation, or funding. RESULTS Only 0,4% (n=16) of 4404 funded projects included -totally or partially- LGTBIQ+community, which represents only 0,3% of the funding. LGTBIQ+projects mainly focused on men who have sex with men (n=14) and the human immunodeficiency viruses (HIV) (n=11). The number of funded LGTBIQ+projects decreased from 2013 (n=6) to 2019 (n=0). CONCLUSIONS Research projects on LGTBIQ+health are scarce in Spain. Current funding for research on LGTBIQ+health is insufficient to care for population other than HIV and men within LGTBIQ+. There is a compelling necessity to promote the LGTBIQ+health research to mitigate health disparities, to offer inclusive health services, and to improve healthcare of about 3 million LGTBIQ+people living in Spain.
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20
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Karakaya S, Kutlu FY. LGBT individuals' opinions about their health care experiences: A qualitative research study. J Nurs Manag 2020; 29:24-31. [PMID: 33128281 DOI: 10.1111/jonm.13199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
AIM To determine the health problems of LGBT individuals and the conditions of their utilization of health care services from their own perspectives. BACKGROUND Although the health care services have improved over the last decades, LGBT individual still face unique challenges when seeking health care services. METHOD This study was performed using the phenomenological technique as a qualitative research method. The sample consisted of 18 LGBT individuals selected using purposive sampling. Data were collected by semi-structured interviews using focus group and analysed using content analysis. RESULTS Two main themes emerged as a result of the content analysis: awareness and status of benefiting from health care. CONCLUSION To obtain quality care for LGBT individuals, the health care professionals need a persistent awareness-specific knowledge of LGBT health issues. IMPLICATIONS FOR NURSING MANAGEMENT The findings of this study can be a warning for managers and policymakers to plan seriously to reform health care services infrastructures. Content about the health needs of LGBT individuals can be added to the curriculum of medical and nursing schools.
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Affiliation(s)
- Seda Karakaya
- Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatma Yasemin Kutlu
- Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
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21
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Zeeman L, Aranda K. A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186533. [PMID: 32911732 PMCID: PMC7559554 DOI: 10.3390/ijerph17186533] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 01/22/2023]
Abstract
Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review of intersex health and healthcare inequalities by evaluating research published from 2012 to 2019. In total 9181 citations were identified with 74 records screened of which 16 were included. A synthesis of results spans nine quantitative, five qualitative and two narrative reviews. Literature was searched in Medline, Web of Science, Cochrane, PsycInfo and CINAHL. People with intersex variance experience a higher incidence of anxiety, depression and psychological distress compared to the general population linked to stigma and discrimination. Progressive healthcare treatment, including support to question normative binaries of sex and gender, aids understand of somatic intersex variance and non-binary gender identity, especially when invasive treatment options are avoided or delayed until individuals are able to self-identify or provide consent to treatment. Findings support rethinking sex and gender to reflect greater diversity within a more nuanced sex-gender spectrum, although gaps in research remain around the general health profile and the healthcare experiences of people with intersex variance. More large-scale research is needed, co-produced with peers who have lived experience of intersex variation to ensure policy, education and healthcare advances with greater inclusivity and ethical accountability.
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Affiliation(s)
- Laetitia Zeeman
- School of Health Sciences, University of Brighton, Brighton BN1 9PH, UK;
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton BN2 0JG, UK
- Correspondence: ; Tel.: +44-0-1273-64-4194
| | - Kay Aranda
- School of Health Sciences, University of Brighton, Brighton BN1 9PH, UK;
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton BN2 0JG, UK
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Donisi V, Amaddeo F, Zakrzewska K, Farinella F, Davis R, Gios L, Sherriff N, Zeeman L, Mcglynn N, Browne K, Pawlega M, Rodzinka M, Pinto N, Hugendubel K, Russell C, Costongs C, Sanchez-Lambert J, Mirandola M, Rosinska M. Training healthcare professionals in LGBTI cultural competencies: Exploratory findings from the Health4LGBTI pilot project. PATIENT EDUCATION AND COUNSELING 2020; 103:978-987. [PMID: 31866197 DOI: 10.1016/j.pec.2019.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 05/14/2023]
Abstract
OBJECTIVES Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience health inequalities and barriers to accessing healthcare at a greater rate than the general population. This paper aims to present the Health4LGBTI training course for healthcare workers and the results of its pilot implementation. METHODS Funded by the European Parliament, the training course was developed by a multidisciplinary team including LGBTI organisations as part of the Health4LGBTI Project. 110 healthcare professionals from diverse medical fields attended the pilot training in six European Member States. Knowledge and attitudes were compared on the basis of a pre-post evaluation design utilising an ad hoc questionnaire. RESULTS Knowledge scores increased after the training, irrespective of age and sexual orientation of participants. Attitudes scores generally improved, particularly in terms of inclusivity and a greater acknowledgement of LGBTI health needs and self-competence. CONCLUSION The Health4LGBTI training course is both feasible and effective in training healthcare professionals and support staff to improve cultural competence and thereby promoting inclusive healthcare practice. PRACTICE IMPLICATIONS The Health4LGBTI training course can be implemented in different healthcare contexts. Piloting of the course provided an opportunity for healthcare professionals and for support staff to improve their knowledge of, and attitudes towards, LGBTI people.
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Affiliation(s)
- Valeria Donisi
- University of Verona, Department of Neurosciences, Biomedicine and Movement, Verona, Italy
| | - Francesco Amaddeo
- University of Verona, Department of Neurosciences, Biomedicine and Movement, Verona, Italy
| | - Karolina Zakrzewska
- National Institute of Public Health - National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance, Warsaw, Poland
| | - Francesco Farinella
- University of Verona, Department of Neurosciences, Biomedicine and Movement, Verona, Italy
| | - Ruth Davis
- University of Verona, Department of Neurosciences, Biomedicine and Movement, Verona, Italy; University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Lorenzo Gios
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Nigel Sherriff
- University of Brighton, School of Health Sciences, Brighton, UK; University of Brighton, Centre for Transforming Sexuality and Gender, School of Media, Brighton, UK
| | - Laetitia Zeeman
- University of Brighton, School of Health Sciences, Brighton, UK; University of Brighton, Centre for Transforming Sexuality and Gender, School of Media, Brighton, UK
| | - Nick Mcglynn
- University of Brighton, School of Environment & Technology, Brighton UK
| | | | - Michal Pawlega
- National Institute of Public Health - National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance, Warsaw, Poland
| | - Marcin Rodzinka
- National Institute of Public Health - National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance, Warsaw, Poland
| | - Nuno Pinto
- The International Lesbian, Gay, Bisexual, Trans and Intersex Association - ILGA Europe, Brussels, Belgium
| | - Katrin Hugendubel
- The International Lesbian, Gay, Bisexual, Trans and Intersex Association - ILGA Europe, Brussels, Belgium
| | - Cianan Russell
- The International Lesbian, Gay, Bisexual, Trans and Intersex Association - ILGA Europe, Brussels, Belgium
| | | | | | - Massimo Mirandola
- University of Verona, Department of Diagnostics and Public Health, Verona, Italy
| | - Magdalena Rosinska
- National Institute of Public Health - National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance, Warsaw, Poland.
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