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Hascher K, Jaiswal J, LoSchiavo C, Ezell J, Duffalo D, Greene RE, Cox A, Burton WM, Griffin M, John T, Grin B, Halkitis PN. Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care. J Gen Intern Med 2024; 39:2023-2032. [PMID: 38308157 PMCID: PMC11306825 DOI: 10.1007/s11606-024-08635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Sexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population's health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings. OBJECTIVE To explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs. DESIGN Semi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018. PARTICIPANTS The study included a sample of 43 young adult SMM (ages 25-27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City. APPROACH Researchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts. KEY RESULTS Analyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants' identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers. CONCLUSIONS SMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients' preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.
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Affiliation(s)
- Kevin Hascher
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jessica Jaiswal
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Jerel Ezell
- Department of Community Health Sciences, UC Berkeley, Berkeley, CA, 94720, USA
- Center for Cultural Humility, UC Berkeley, Berkeley, CA, 94720, USA
| | - Danika Duffalo
- School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, 10001, USA
| | - Amanda Cox
- Culverhouse College of Business, University of Alabama, Tuscaloosa, AL, USA
| | - Wanda M Burton
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, 35401, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Tejossy John
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA
| | - Benjamin Grin
- Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, MO, 64106, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, 07102, USA
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Ben-Zacharia AB, Smrtka J, Kalina JT, Vignos M, Smith S. Shared decision-making in underserved populations with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2024; 90:105792. [PMID: 39121597 DOI: 10.1016/j.msard.2024.105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The concept of shared decision-making (SDM) is valuable to ensure patients receive individualized care. SDM occurs when healthcare providers engage patients in making personal healthcare decisions that could contribute to better long-term outcomes. With the ever-increasing landscape of treatment options available, SDM can be challenging but valuable for patients. Patients from underserved populations are potentially less likely to engage in SDM, impacting their long-term care. This systematic literature review aimed to explore SDM in these patient populations. METHODS Relevant articles were retrieved from PubMed using key search terms, without any restriction on publication date. All searches and data retrieval were conducted between May 25, 2022, and August 17, 2022, and abstracts were reviewed by two independent reviewers. A thematic analysis was used to present the data. RESULTS All search terms yielded 418 articles; 89 were included (33 involving patients with multiple sclerosis [MS]). Reported mean percentage of patients with MS (including from underserved populations) who preferred SDM was 52 % (range: 37.5-71.5; n = 4). Differences in racial/ethnic assimilation of information communicated by clinicians were reported, impacted by the lower literacy level and certain cultural health beliefs in groups of underserved populations. Primary care clinicians play a key role in providing information to patients in underserved populations. CONCLUSIONS There is a clear benefit for SDM for patients with MS, and without it, patients report dissatisfaction, decisional regret, and lack of confidence in the medical system. However, there are several challenges, including the need for further examination of social determinants of health, for underserved patient populations which still need to be addressed.
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Affiliation(s)
- Aliza Bitton Ben-Zacharia
- Hunter Bellevue School of Nursing and Mount Sinai Hospital; Hunter Bellevue School of Nursing, 425 E 25th St, New York, NY 10010, USA; Mount Sinai, 146 East 126 Street, New York, NY 10035, USA.
| | - Jen Smrtka
- Biogen, 225 Binney St, Cambridge, MA 02142, USA
| | | | | | - Stacyann Smith
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA
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Brener S, Jiang S, Hazenberg E, Herrera D. A Cyclical Model of Barriers to Healthcare for the Hispanic/Latinx Population. J Racial Ethn Health Disparities 2024; 11:1077-1088. [PMID: 37039976 DOI: 10.1007/s40615-023-01587-5] [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: 12/29/2022] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023]
Abstract
As the Hispanic/Latinx population in the United States continues to grow, disparities in health outcomes for this population continue to widen. Worse health outcomes can be attributed to a variety of barriers to healthcare specific to this population, but scant literature exists that presents the connections among them. Many of these barriers to healthcare stem from institutional racism, disparities in socioeconomic status, and xenophobia. To synthesize barriers that hinder the Hispanic/Latinx population from receiving quality healthcare, we propose a cyclical model. The model begins with obstacles present before even visiting a healthcare provider, including structural inequalities, cultural beliefs, documentation status, scheduling, and transportation. Next, the model poses barriers during the visit with a healthcare provider, including problems with provider bias, cultural barriers, and interpretation services. Finally, the model presents barriers that occur after the medical encounter, including payment, medication adherence, indigent care, and follow-up appointments or referrals. Once the patient needs to schedule a follow-up appointment or referral, the cycle restarts with the barriers present before accessing care. All of these barriers to healthcare are areas for potential mitigation of the healthcare disparities that currently disadvantage the Hispanic/Latinx population. The proposed Hispanic Cyclical Healthcare Barrier (HCHB) model helps organize solutions to the barriers, illustrating the need for multiple interventions due to the interconnectedness of the barriers.
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Wang Y, Beltran RM, Cumberland WG, Young SD. Factors Associated with COVID-19 Testing, Vaccination, and Use of Digital Contact Tracing Apps among Black and Latinx MSM (BLMSM) in Los Angeles. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01750-y. [PMID: 37566181 PMCID: PMC10953315 DOI: 10.1007/s40615-023-01750-y] [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: 02/21/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
This study examines the factors associated with COVID-19 testing, vaccination intent (both individually and jointly), and willingness to use contact tracing digital apps among a cohort of Black and Latinx men who have sex with men (BLMSM) living in Los Angeles during the initial peak (July 2020) of the COVID-19 pandemic. A questionnaire detailing participants COVID-19 experiences was sent to 300 primarily BLMSM after the first state-wide COVID-19 lockdown. Logistic regression models with random cluster effects were used for analyses. Forty-two percent (42%) tested for COVID-19, 27% were willing to get vaccinated, and about 45% reported willingness to use contact tracing digital apps. Controlling for intervention participation, age, education, marital status, employment, health, tobacco, binge drinking, and self-reported anxiety, those who were depressed had 33% (95% CI: 0.13 to 0.82) odds of using a prevention strategy (either test for COVID-19 or vaccination intent) as the group who were not depressed. Those who had high school diploma or less had 23% (95% CI: 0.11 to 0.48) odds to use digital contact tracing apps as the group with education level of at least Associate's or Bachelor's degree. Without considering the format of the test kits, vaccine side effects, and ease of use for digital contact tracing apps, participants appeared to still be hesitant in using COVID-19 prevention strategies at the initial height of the pandemic. Our findings suggest the need for further investigation into this hesitancy to better inform and prepare for future epidemics.
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Affiliation(s)
- Yan Wang
- Section of Public and Population Health, Division of Oral and Systemic Health Sciences, School of Dentistry, University of California, Los Angeles (UCLA), 10833 La Conte, Los Angeles, CA, 90095, USA.
| | - Raiza M Beltran
- Luskin School of Public Affairs, UCLA, 10833 La Conte, Los Angeles, CA, 90095, USA
| | - William G Cumberland
- Department of Biostatistics, Fielding School of Public Health, UCLA, 10833 La Conte, Los Angeles, CA, 90095, USA
| | - Sean D Young
- Department of Emergency Medicine, School of Medicine and Informatics, Information and Computer Sciences, University of California, Irvine, City Tower, Ste 640, Rt 128-01, Irvine, CA, 92697, USA
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Burdick S, Nicholus S. A Pilot Study of Latinx Lesbian, Gay, and Bisexual Adolescent Patients' Goal Prioritizations in Patient-Provider Sexual Orientation and Health Disclosures. HEALTH COMMUNICATION 2022; 37:1215-1228. [PMID: 34334073 DOI: 10.1080/10410236.2021.1957213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This pilot study provides a theoretically-driven explanation of the dilemmas young Latinx LGB patients may experience surrounding disclosure of personal sexual orientation and sexual health information to a health care provider (HCP). The research team conducted face-to-face semi-structured interviews with LGB Latinx individuals (N= 29) ages 18-22 about their experiences, concerns, and preferences regarding divulging this type of information to an HCP. Interviews were thematically analyzed to identify (a) participants' instrumental, identity, and relational goals during the potential and real disclosures and (b) patterns of how the participants prioritized their goals. Thematic analysis revealed four distinct goal prioritization patterns detailed in this study. Participants' goals were shaped by (a) cultural upbringing, (b) beliefs about human sexuality, (c) perception of data leakage risk, (d) individual personality, (e) medical situation, and (f) the geographic location of clinic.
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Affiliation(s)
- Suzanne Burdick
- Department of Communication Studies, University of Texas at Austin
| | - Sarah Nicholus
- Women's, Gender, and Sexuality Studies, University of Texas at Austin
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Counce TL, Ko A, Martinez AD, Rivera JM, Browne C, Solis L. Utilizing the Four Tenets of Osteopathic Medicine as an intersectional framework for approaching sexual orientation and gender identity disclosure as a provider. J Osteopath Med 2021; 121:875-881. [PMID: 34648700 DOI: 10.1515/jom-2020-0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/01/2021] [Indexed: 11/15/2022]
Abstract
The Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and other (LGBTQI+) community continues to experience health inequity and unmet needs. This manuscript examines the application of the Four Tenets of Osteopathic Medicine (FTOM) during a patient's self-disclosure of their sexual orientation and/or gender identity to the provider, also known as coming out. Tenet One discusses the interplay between intersectionality and coming out. Tenet Two elucidates how coming out moves toward a balance of homeostasis and self-healing. Tenet Three examines how structure and function can be understood on a personal level and how society influences coming out. Tenet Four explains the resources available to facilitate the previously forementioned changes. By applying the Four Tenets, the provider may more readily understand what "coming out" means on personal and social levels and what implications they may have on their patients' health.
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Affiliation(s)
- Timothy L Counce
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Amy Ko
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Anthony D Martinez
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Jenna M Rivera
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Carol Browne
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Linda Solis
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
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Baker AM, Jahn JL, Tan AS, Katz-Wise SL, Viswanath K, Bishop RA, Agénor M. Sexual Health Information Sources, Needs, and Preferences of Young Adult Sexual Minority Cisgender Women and Non-Binary Individuals Assigned Female at Birth. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 18:775-787. [PMID: 34484461 PMCID: PMC8414874 DOI: 10.1007/s13178-020-00501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Young adult sexual minority women (SMW) have unique sexual health needs and higher rates of some poor sexual health outcomes compared to their heterosexual peers. Unequal access to relevant sexual health information may contribute to sexual orientation disparities in sexual health among women, but research on sexual health communication among SMW is sparse. METHODS In-depth interviews conducted in 2016-2017 investigated sexual health communication in a sample of 29 racially/ethnically diverse cisgender women and non-binary individuals assigned female at birth who were between 19 and 36 years of age and identified as a sexual minority. Data were analyzed using a thematic analysis approach that involved inductive and deductive coding to identify themes. RESULTS Three broad themes were identified: 1) sources of sexual health information; 2) sexual health information needs; and 3) preferences for sexual health information delivery. Participants discussed and critiqued the Internet, other mass media, health care providers, school-based sex education, family, and peers/partners as sources of sexual health information. Participants expressed a need for customized, non-heteronormative information pertaining to sexually transmitted infection risk and prevention. They preferred receiving information from health care providers, the Internet, and other mass media, and some also suggested school-based sex education and peer education as methods for delivering information. CONCLUSIONS Participants expressed clear desires for relevant, high-quality sexual health information delivered through a variety of channels, especially the Internet, other mass media, and health care providers. POLICY IMPLICATIONS Findings call for policies that improve provision of sexual health information through health care providers, online resources, and school-based sex education.
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Affiliation(s)
- Allison M. Baker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaquelyn L. Jahn
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andy S.L. Tan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Sabra L. Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rachel A. Bishop
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Executive Office of Health & Human Services, Commonwealth of Massachusetts, Boston, MA, USA
| | - Madina Agénor
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Community Health, Tufts University, Medford, MA, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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Behavioral and social science research to support accelerated and equitable implementation of long-acting preexposure prophylaxis. Curr Opin HIV AIDS 2021; 15:66-72. [PMID: 31644482 DOI: 10.1097/coh.0000000000000596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The sociobehavioral research agenda for HIV prevention urgently needs to progress beyond research on end user preferences to examine how to best support patient access, engagement, and choice in the rollout of long-acting modalities. We outline critical challenges for an era of choice in biomedical prevention that could benefit from the rigorous application of sociobehavioral research methods. RECENT FINDINGS Research in three areas could accelerate implementation of long-acting antiretrovirals for prevention: integrating dual process models into research on patient decision-making and behavior; identifying strategies that mitigate against unconscious and implicit biases in provider decision-making and behavior; and developing tools to support patient-centered communication that incorporate research in both of the first two areas. SUMMARY We encourage the development of dual process models and measures to better understand patient behavior, including behavior related to initiating biomedical prevention, choice of prevention strategy, switching among strategies, and discontinuation. Second, there is the need to develop intervention research that targets provider behavior. Finally, we call for research to inform patient-centered communication tools that integrate an understanding of affective drivers of preexposure prophylaxis (PrEP) decision-making and protect against implicit bias in provider recommendations related to PrEP.
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Scalia P, Tighe KM, Elwyn G, Bagley PJ, Blunt HB, Boh B, Walters OC, Moses RA. A systematic review of decision aids for gender affirming therapy. Transl Androl Urol 2021; 10:2574-2582. [PMID: 34295744 PMCID: PMC8261453 DOI: 10.21037/tau-20-1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transgender and gender diverse (TGD) persons considering gender affirming therapy have to make many complex medical decisions, potentially without understanding the associated harms or benefits of hormonal and surgical interventions. Further, clinicians are often unaware of how best to communicate information to persons seeking gender affirming therapy. Patient decision aids have been developed to provide evidence-based information as a way to help people make decisions in collaboration with their clinicians. It is unclear whether such tools exist for persons seeking gender affirming therapy. The objective of our systematic review is to search for and determine the quality of any existing patient decision aids developed for TGD persons considering gender affirming therapy, and the outcomes associated with their use. METHODS We adapted a search strategy for databases using two key concepts "decision support intervention/patient decision aid" and "transgender". We also conducted a brief online search of Google and abstracts from relevant conferences to identify any tools not published in the academic literature. Following study selection and data extraction, we used the International Patient Decision Aid Standards instrument (IPDASi) to assess the quality of patient decision aids, and the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) checklist to assess the quality of evaluations. RESULTS We identified 762 studies; none were identified from Google or conference content. One tool met our inclusion criteria: an online, pre-encounter patient decision aid for transmasculine genital gender-affirming surgery developed in Amsterdam, translated in English and Dutch. The tool met all the IPDASi qualifying criteria, and scored a 17/28 on the certification criteria, and 57/112 on the quality criteria. The efficacy of the patient decision aid has not been evaluated. CONCLUSIONS Despite multiple decisions required for gender affirming therapies, only one patient decision aid has been developed for transmasculine genital reconstruction. Further research is required to develop patient decision aids for the multiple decision points along the gender affirming journey.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Katherine M. Tighe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | | | - Benjamin Boh
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Bi S, Vela MB, Nathan AG, Gunter KE, Cook SC, López FY, Nocon RS, Chin MH. Teaching Intersectionality of Sexual Orientation, Gender Identity, and Race/Ethnicity in a Health Disparities Course. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10970. [PMID: 32754634 PMCID: PMC7394350 DOI: 10.15766/mep_2374-8265.10970] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/28/2020] [Indexed: 05/30/2023]
Abstract
Introduction Intersectionality considers how different identities simultaneously affect an individual's experiences. Those of multiple minority statuses may experience effects of intersecting systems of oppression. Most health disparities curricula do not focus on intersectionality. We studied the impact of an innovative module teaching intersectionality of sexual orientation, gender identity, and race/ethnicity issues in the required Pritzker School of Medicine course Health Care Disparities: Equity and Advocacy. Methods A short lecture reviewed sexual and gender minority (SGM) health disparities, intersectionality, minority stress, and shared decision making (SDM) to establish shared language among 83 first-year medical students. Students then viewed four videos of SGM patients of color (POC) describing their health care experiences, each followed by moderated discussion about how compounded minority stress affects lived experiences and health and how to improve SDM for SGM POC. One video interviewee attended the session and answered students' questions. Evaluation was performed using pre- and postsurveys. Results Feeling somewhat/completely confident in defining intersectionality increased from 57% to 96%. Prior to the session, 62% of respondents reported feeling somewhat/completely confident in identifying barriers to care for SGM patients, and 92% after. Thirty-three percent felt somewhat/completely confident in asking SGM patients about their identities before the session, and 81% after. Eighty-four percent rated the session as very good or excellent. Discussion The session was well received, improved student knowledge of intersectionality, and improved confidence in communicating with and caring for SGM patients. Future iterations could include condensing the lecture and including a patient panel and/or small-group discussion.
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Affiliation(s)
- Stephanie Bi
- Student, University of Chicago Pritzker School of Medicine
| | - Monica B. Vela
- Professor, Department of Medicine, University of Chicago; Associate Dean for Multicultural Affairs, University of Chicago Pritzker School of Medicine
| | - Aviva G. Nathan
- Senior Research Project Manager, Department of Medicine, University of Chicago
| | | | - Scott C. Cook
- Clinical Psychologist, Department of Medicine, University of Chicago
| | - Fanny Y. López
- Project Manager, Office of Diversity, Equity and Inclusion, Dominican University; Adjunct Instructor, Office of Diversity, Equity and Inclusion, Dominican University
| | - Robert S. Nocon
- Senior Health Services Researcher, Department of Medicine, University of Chicago
| | - Marshall H. Chin
- Richard Parrillo Family Professor of Healthcare Ethics, Department of Medicine, University of Chicago
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Agénor M, Pérez AE, Tabaac AR, Bond KT, Charlton BM, Bowen DJ, Austin SB. Sexual Orientation Identity Disparities in Mammography Among White, Black, and Latina U.S. Women. LGBT Health 2020; 7:312-320. [PMID: 32668184 PMCID: PMC7475089 DOI: 10.1089/lgbt.2020.0039] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: Our goal was to examine sexual orientation identity disparities in mammography in relationship to race/ethnicity among U.S. women. Methods: Using nationally representative 2013-2017 National Health Interview Survey data, we used multivariable logistic regression to estimate the odds of receiving a mammogram in the past year in relationship to sexual orientation identity among White, Black, and Latina U.S. women 40-75 years of age (N = 45,031) separately, adjusting for demographic factors. We also assessed whether socioeconomic and health care factors attenuated sexual orientation identity disparities in mammography across racial/ethnic groups. Results: Among White women, bisexual women had significantly lower adjusted odds of mammography compared to heterosexual women (odds ratio = 0.70, 95% confidence interval: 0.50-0.99). Among Black women, the adjusted odds of mammography were significantly higher among bisexual women relative to heterosexual women (2.53, 1.08-5.92). Black lesbian women appeared to have lower adjusted odds of mammography compared to their heterosexual counterparts; however, this difference was not statistically significant (0.80, 0.46-1.38). Similarly, among Latina women, lesbian women also seemed to have lower adjusted odds of mammography relative to heterosexual women, but this disparity was also not statistically significant (0.64, 0.37-1.13). Adding socioeconomic factors completely attenuated the disparity between White bisexual and heterosexual women (0.76, 0.52-1.10). Conclusions: Sexual orientation identity disparities in receiving a mammogram in the past year differed in relationship to race/ethnicity among White, Black, and Latina U.S. women. Additional research with larger samples of Black and Latina lesbian and bisexual women is needed to more accurately estimate and explain observed differences.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ashley E. Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ariella R. Tabaac
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Keosha T. Bond
- Department of Public Health, New York Medical College, Valhalla, New York, USA
| | - Brittany M. Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - S. Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Lady SD, Burnham KD. Sexual Orientation and Gender Identity in Patients: How to Navigate Terminology in Patient Care. JOURNAL OF CHIROPRACTIC HUMANITIES 2019; 26:53-59. [PMID: 33911987 PMCID: PMC8074683 DOI: 10.1016/j.echu.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/09/2019] [Accepted: 08/21/2019] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this paper is to describe how health care providers can improve their practice environments to be more welcoming for patients on the spectrum of gender and sexual identity. METHODS Literature searches were performed in WorldCat, PubMed, and nongovernmental organizations and Gallup polls. The years searched were from 2005 to 2018. Key words used included sexual orientation, transgender, and health care. The PubMed MeSH termed searched included gender identity and sexuality, both in combination with patient care. RESULTS Terminology that patients use to identify their gender may vary. Understanding the terminology that patients use to self-identify is a first step to becoming more sensitive to the needs of gender and sexual minority patients. Minority patients on the spectrum of gender and sexual identity experience discrimination when accessing health care. Therefore, an accepting doctor-patient relationship especially benefits these patients. When communication competency and fluency is established, health care providers provide a more inclusive, accepting environment. Addressing patients based on their preferences and using inclusive forms and patient handouts are some recommendations that are made to create an open, patient-centered environment. CONCLUSION This article provides health care providers with terminology that facilitates communication and the healing environment for sexual and gender minority patients. Understanding and using this may create a more welcoming environment to all patients.
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Affiliation(s)
- Suzanne D. Lady
- Department of Clinical Education, University of Western States, Portland, OR
| | - Kara D. Burnham
- Department of Basic Sciences, University of Western States, Portland, OR
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Healthcare Experiences of Transgender People of Color. J Gen Intern Med 2019; 34:2068-2074. [PMID: 31385209 PMCID: PMC6816758 DOI: 10.1007/s11606-019-05179-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/11/2018] [Accepted: 04/09/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transgender people and racial/ethnic minorities separately report poor healthcare experiences. However, little is known about the healthcare experiences of transgender people of color (TPOC), who are both transgender and racial/ethnic minorities. OBJECTIVE To investigate how TPOC healthcare experiences are shaped by both race/ethnicity and gender identity. DESIGN AND PARTICIPANTS Semi-structured, in-depth individual interviews (n = 22) and focus groups (2; n = 17 total); all taken from a sample of TPOC from the Chicago area. All participants completed a quantitative survey (n = 39). APPROACH Interviews and focus groups covered healthcare experiences, and how these were shaped by gender identity and/or race/ethnicity. The interviews and focus groups were audio recorded, transcribed verbatim, and imported into HyperRESEARCH software. At least two reviewers independently coded each transcript using a codebook of themes created following grounded theory methodology. The quantitative survey data captured participants' demographics and past healthcare experiences, and were analyzed with descriptive statistics. KEY RESULTS All participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants believed they would be treated better if they were cisgender or white. Participants commonly cited providers' assumptions about TPOC as a pivotal factor in negative experiences. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender (LGBT)-friendly in an effort to avoid discrimination, but feared experiencing racism there. A minority of participants expressed a preference for providers of color; but a few reported reluctance to reveal their gender identity to providers of their own race due to fear of transphobia. When describing positive healthcare experiences, participants were most likely to highlight providers' respect for their gender identity. CONCLUSIONS TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities. Providers must improve understanding of intersectional experiences of TPOC to improve quality of care.
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Albuquerque MRTCD, Botelho NM, Rodrigues CCP. Atenção integral à saúde da população LGBT: Experiência de educação em saúde com agentes comunitários na atenção básica. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)1758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Relatar uma experiência de educação em saúde com agentes comunitários de saúde acerca da saúde da população LGBT na atenção básica. Métodos: Foi realizada uma ação de educação continuada por meio do estudo de casos escolhidos pelos agentes de saúde dentro de suas microáreas de atuação seguida de discussão em grupo e reflexão sobre as práticas vigentes. Resultados: Foram discutidos três casos apresentados pelos agentes de saúde que abordavam as temáticas de: (1) a escola e o preconceito; (2) a importância do apoio familiar e social; e (3) o papel da estratégia saúde da família e da educação em saúde. Percebeu-se que o tema permanece excluído das grandes discussões, sobretudo nas escolas médicas e na atenção básica, que é o primeiro contato do usuário com o Sistema Único de Saúde. Dessa forma, estratégias que objetivem discutir as peculiaridades da prevenção, promoção e assistência à saúde desses grupos devem ser estimuladas e reproduzidas tendo em vista uma melhor qualidade do atendimento a fim de captar esses pacientes em um ambiente favorável a práticas integrativas com respeito à diversidade sexual. Conclusão: Conclui-se que a atividade educacional realizada foi de extrema importância para desmistificar mitos e preconceitos envolvendo a saúde LGBT no cenário da atenção básica. Observou-se que após a atividade educacional os ACS se mostraram mais confiantes e sensibilizados sobre as temáticas abordadas e mudaram concepções no sentido de respeitar as decisões dos pacientes e realizar abordagem adequada para o acolhimento a esses usuários.
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Wilson Y, White A, Jefferson A, Danis M. Intersectionality in Clinical Medicine: The Need for a Conceptual Framework. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:8-19. [PMID: 30784384 DOI: 10.1080/15265161.2018.1557275] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient-clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.
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Affiliation(s)
| | | | - Akilah Jefferson
- c University of California San Diego and Rady Children's Hospital San Diego
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High Stakes for the Health of Sexual and Gender Minority Patients of Color. J Gen Intern Med 2017; 32:1390-1395. [PMID: 28798997 PMCID: PMC5698216 DOI: 10.1007/s11606-017-4138-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/09/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022]
Abstract
As clinicians, educators, and researchers, our ability to provide the best possible care to our patients who are sexual and gender minority (SGM) people of color is increasingly challenged. Relative to the general population, SGM patients often have worse health outcomes, and among SGM patients, racial and ethnic minorities are particularly vulnerable. Healthcare policies proposed by the current administration, along with an increasingly hostile and dangerous social climate, have the potential to seriously harm SGM patients of color. In this paper, we discuss these key policy issues impacting the health of SGM patients of color. We then suggest questions for clinicians to consider to help them decide which advocacy activities are right for them, recommending self-examination, skills development, and political action. We end by outlining concrete, actionable steps to advocate for SGM patients of color in patient care, healthcare organizations, medical education, research, and public policy.
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Gibson AW, Radix AE, Maingi S, Patel S. Cancer care in lesbian, gay, bisexual, transgender and queer populations. Future Oncol 2017; 13:1333-1344. [DOI: 10.2217/fon-2017-0482] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Lesbian, gay, bisexual, transgender and queer (LGBTQ) populations experience health and healthcare disparities that may place them at higher risk for developing cancer. In addition, LGBTQ communities have psychosocial factors, such as fear of discrimination, that have substantial impacts on their medical care. As a result, these populations have specific needs with regard to cancer screening, treatment and support that must be addressed by cancer care providers. Although much has been done to address cancer care in the general population, more improvement is needed in the care of LGBTQ patients. We aim to present an overview of the current state of LGBTQ cancer care, opportunities for improvement and how cancer centers and providers can create a better future for the care of LGBTQ cancer patients.
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Affiliation(s)
- Alec W Gibson
- Medical Scientist Training Program & Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, NY, USA
| | - Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, Troy, NY, USA
| | - Shilpen Patel
- Department of Radiation Oncology & Department of Global Health, University of Washington, Seattle, WA, USA
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Affiliation(s)
- Henry H Ng
- Center for Internal Medicine/Pediatrics, MetroHealth Medical Center , Cleveland, Ohio
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