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Maoto M, Davis B. Breaking barriers: How transwomen meet their healthcare needs. Afr J Prim Health Care Fam Med 2024; 16:e1-e6. [PMID: 38949443 PMCID: PMC11220124 DOI: 10.4102/phcfm.v16i1.4598] [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: 05/01/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Transgender women - individuals assigned male at birth but who identify as female - are disproportionately affected by, among others, human immunodeficiency virus (HIV), other sexually transmitted diseases (STIs) and mental health issues. Studies show that transgender women often encounter discrimination and stigma when seeking healthcare from health facilities. AIM This study assessed the healthcare needs of transgender women, their experiences of the mainstream healthcare system and alternative strategies for navigating the healthcare system. SETTING The study was carried out in the City of Ekurhuleni Metropolitan Council in South Africa's Gauteng province. METHODS A case study design was followed. Participants were purposively selected and included 10 transgender women aged 26-50. Individual semi-structured interviews were conducted over 2 months. RESULTS Participants expressed a need for hormone replacement therapy, HIV treatment and prevention and treatment for STIs. Experiences of participants within the healthcare system were predominantly negative, with instances of discrimination, stigma and privacy violations being commonplace. Alternative strategies to meet their healthcare needs included the use of self-medication, consulting traditional healers and utilising non-governmental organisations. CONCLUSION There is an urgent need for equitable and inclusive health management of transgender women in South Africa.Contribution: This study provided a first look in a South African context into how and to what extent transwomen employ alternative healthcare strategies such as self-medication and utilising non-governmental organisations when faced with mainstream healthcare access barriers. The use of traditional doctors was identified as a novel, alternative strategy used by transwomen to access healthcare and treatment.
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Affiliation(s)
- Millicent Maoto
- Africa Centre for HIV/Aids Management, Faculty of Economics and Management Sciences, Stellenbosch University, Stellenbosch.
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Ai W, Shi L, Tan RKJ, Wu D, Ong JJ, Qiu T, Marley G, Tucker JD, Chen Y, Yuan D, Fan C, Fu G, Tang W. HIV Services Uptake Among People Living with HIV in Jiangsu Province, China: A Cross-Sectional Study. AIDS Behav 2024:10.1007/s10461-024-04291-5. [PMID: 38493282 DOI: 10.1007/s10461-024-04291-5] [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] [Accepted: 02/05/2024] [Indexed: 03/18/2024]
Abstract
Healthcare disparities are common among people living with HIV (PLWH) in China and likely impact access to HIV services. This study aimed to assess the current status of access to HIV services among PLWH and explore the correlates of service uptake using baseline data from a prospective cohort study among PLWH in Jiangsu Province. Guided by Andersen's behavioral model, univariable and multivariable logistic regressions were conducted to identify factors associated with access to HIV services. Out of 8989 eligible PLWH included in this study, 46.4% perceived difficulty in seeing a healthcare professional for HIV treatment services in 2021-2022. PLWH aged 18-34 years (adjusted odds ratio [AOR] = 1.69, 95% CI 1.32-2.15), 35-39 years (AOR = 1.33, 95% CI 1.08-1.65), identified as a bisexual/other (AOR = 1.14, 95% CI 1.01-1.29), had a college and above education (AOR = 1.32, 95% CI 1.07-1.63), and perceived moderate (AOR = 1.70, 95% CI 1.51-1.91) and severe (AOR = 2.20, 95% CI 1.94-2.49) levels of HIV stigma were more likely to perceive difficulty in seeing healthcare professionals for HIV treatment in 2021-2022. Living in northern Jiangsu was also associated with increased odds of perceiving difficulty in seeing healthcare professionals for HIV treatment (AOR = 1.12, 95% CI 1.00-1.26). These findings underscore the need for innovative solutions to eliminate the practical barriers to HIV services utilization among PLWH who are bisexual, well-educated, and effective HIV-related stigma reduction interventions.
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Affiliation(s)
- Wei Ai
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China
| | - Dan Wu
- School of Public Health, Nanjing Medical University, Nanjing, China
- University of North Carolina Project-China, Guangzhou, China
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Tao Qiu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yuheng Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Chengxin Fan
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
| | - Weiming Tang
- School of Public Health, Nanjing Medical University, Nanjing, China.
- University of North Carolina Project-China, Guangzhou, China.
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Carmichael TN, Copel LC, McDermott-Levy R. Effect of an Education Intervention on Nursing Students' Knowledge of and Attitudes Toward Caring for Transgender and Nonbinary People. Nurse Educ 2024:00006223-990000000-00396. [PMID: 38235809 DOI: 10.1097/nne.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Transgender and nonbinary (TGNB) people experience inequities in health care access, quality, and outcomes. Health care professionals' lack of knowledge and biased attitudes toward gender minorities contribute to inequitable care. PURPOSE This study examined the effect of TGNB health education on nursing students' knowledge and attitudes about caring for TGNB clients. METHODS A quasi-experimental study using a one-group pretest/posttest design was conducted with 46 nursing students at 2 private baccalaureate nursing programs. RESULTS A paired-samples t test found a significant increase in knowledge about caring for TGNB clients at posttest (P = .02). Attitudes toward caring for TGNB clients showed a significant improvement in the Sex and Gender Beliefs subscale at posttest (P = .014). CONCLUSIONS The findings suggest that TGNB health education is effective for inclusion in nursing curricula to better prepare nurses to care for gender-diverse clients.
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Affiliation(s)
- Tanya N Carmichael
- Author Affiliations: Assistant Professor (Dr Carmichael), School of Nursing, Widener University, Chester, Pennsylvania; and Professor (Drs Copel and McDermott-Levy), M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania
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Zarwell M, Bowling J, Gunn LH, Kissler N, McComas M, Patton A, Ragunathan R, Brown R. Collectives for Care: Perspectives of Providers and Community Members in Transgender Health Care in a Southern U.S. City. JOURNAL OF HOMOSEXUALITY 2024; 71:96-119. [PMID: 35969714 DOI: 10.1080/00918369.2022.2105674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Affirming and accessible health care may improve health outcomes for trans individuals in the U.S. We explored strategies to improve affirming care for trans individuals from the perspectives of providers and transgender and non-binary community members. Forty members of a collective group of gender-affirming providers (GAP) in the southern U.S. were recruited to participate in a brief online survey. A graphical LASSO undirected network analysis approach visualized associations across outcomes and explanatory variables. Multinomial ordered (or logistic, for binary outcomes) models explored associations between a common set of explanatory variables and outcomes. Strong partial correlations (network) and statistically significant explanatory variables (ordinal and logistic models) were identified. Additionally, we conducted three focus groups (FGs) audio-recorded over Zoom with 11 community members. Four study team members analyzed the transcripts using content analyses. Survey results indicated that higher frequency of attendance at monthly provider meetings, additional training, and provision of training and consultation were associated with greater perceived competence among GAP members. To improve services, FG participants suggested treating patients as experts, increasing diversity and representation among providers, and expanding the GAP group. These results highlight the critical need to design and implement community-identified interventions to improve gender-affirming services and enhance provider training.
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Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Neha Kissler
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Megan McComas
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Alexandra Patton
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Roshna Ragunathan
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Rhett Brown
- Novant Health, Charlotte, North Carolina, USA
- Advance Care Midtown, Charlotte, North Carolina, USA
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Roach AP. Exploring The Transgender Individual's Experience With Healthcare Interactions: A Phenomenological Study. J Nurs Scholarsh 2024; 56:31-41. [PMID: 38228565 DOI: 10.1111/jnu.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE The purpose of the study was to provide a transgender narrative on healthcare interactions to increase visibility and awareness of transgender-identified issues in accessing care. This study aimed to: (a) examine how transgender individuals perceive and experience interactions with trained healthcare professionals, such as nurses, physicians, and mental health professionals, (b) identify common issues related to transgender individuals' barriers to care, and (c) identify how these barriers affect a transgender individual's ability to access health care. DESIGN A phenomenological approach was used. METHODS The nine transgender-identified participants received a demographic questionnaire followed by a virtual semi-structured interview. Thematic analysis was used to analyze the interview data. FINDINGS The themes that emerged from the data were (a) challenges with accessing health care, (b) inconsistent healthcare information, and (c) disenfranchised versus empowered experiences. CONCLUSION The results of this study not only provided an opportunity for the transgender participants to share their experiences, but also provides educational information for healthcare providers to improve their future interactions with transgender patients. CLINICAL RELEVANCE Identifying the transgender patient with the correct name and pronoun, providing a welcoming and open healthcare environment, and knowing where to locate transgender health resources will improve the transgender patient's healthcare experience.
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Affiliation(s)
- Amy P Roach
- Wellstar School of Nursing, Kennesaw State University, Kennesaw, Georgia, USA
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Comeau D, Johnson C, Bouhamdani N. Review of current 2SLGBTQIA+ inequities in the Canadian health care system. Front Public Health 2023; 11:1183284. [PMID: 37533535 PMCID: PMC10392841 DOI: 10.3389/fpubh.2023.1183284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.
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Affiliation(s)
- Dominique Comeau
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Claire Johnson
- School of Public Policy Studies, Université de Moncton, Moncton, NB, Canada
| | - Nadia Bouhamdani
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
- Medicine and Health Sciences Faculty, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
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Kidd JD, Kaczmarkiewicz R, Kreski NT, Jackman K, George M, Hughes TL, Bockting WO. A qualitative study of alcohol use disorder psychotherapies for transgender and nonbinary individuals: Opportunities for cultural adaptation. Drug Alcohol Depend 2023; 248:109913. [PMID: 37182356 PMCID: PMC10330671 DOI: 10.1016/j.drugalcdep.2023.109913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Transgender and nonbinary (TGNB) populations experience high rates of hazardous drinking (HD) and alcohol use disorder (AUD) as well as unique treatment barriers. This is due, in-part, to discrimination and stigma within and outside of the healthcare system. Cultural adaptation of clinical interventions can improve outcomes for marginalized populations, but no such adapted interventions exist for AUD among TGNB individuals. This study sought to understand how TGNB individuals perceive currently available AUD psychotherapies and to generate knowledge about potential areas for cultural adaptation. METHODS As part of a qualitative study of HD among TGNB individuals (N=27), participants were asked to imagine that they were clients in psychotherapy vignettes corresponding to cognitive behavioral therapy, motivational enhancement therapy, and twelve step facilitation. Interviews were audio-recorded and professionally transcribed. A coding team used an iterative codebook to guide coding. Categories emerged from this process that reflected participants' perceptions and allowed for the identification of potential cultural-adaptation targets. RESULTS Across all three psychotherapies, participants wanted therapists to explicitly discuss gender identity and culturally salient HD risk factors for TGNB individuals (e.g., discrimination, stigma, gender dysphoria). There were also modality-specific recommendations to incorporate principles of trauma-informed care into cognitive behavioral therapy, avoid motivational enhancement therapy exercises that oversimplify decision-making, and recognize that the twelve-step-facilitation concept of "powerlessness" may conflict with how many TGNB people see themselves. CONCLUSIONS These findings highlight areas for cultural adaptation that can be evaluated in future intervention trials in an effort to improve psychotherapy acceptability and efficacy for TGNB individuals.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Roma Kaczmarkiewicz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA.
| | - Noah T Kreski
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY10032, USA.
| | - Kasey Jackman
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA; New York-Presbyterian Hospital, 622 W. 168th Street, New York, NY10032, USA.
| | - Maureen George
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
| | - Walter O Bockting
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
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Neduzhko O, Saliuk T, Kovtun O, Semchuk N, Varetska O. Community-based HIV prevention services for transgender people in Ukraine: current situation and potential for improvement. BMC Health Serv Res 2023; 23:631. [PMID: 37316821 PMCID: PMC10268490 DOI: 10.1186/s12913-023-09656-5] [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: 08/24/2022] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Community-based HIV-prevention services are a key approach to prevent HIV transmission among key population representatives. Transgender people have multiple specific needs and it is crucial to use prevention approaches that effectively respond to those needs and facilitate barriers on the way to use HIV prevention and related services. This study is aimed to explore the current state of community-based HIV prevention services among transgender people in Ukraine, its limitations and potential for improvement based on the experience and perceptions of transgender people, physicians, and community social workers providing services to transgender people. METHODS Semi-structured in-depth interviews were conducted among physicians providing services to transgender people (N = 10), community social workers (N = 6), and transgender people (N = 30). The objectives of the interviews were to explore: the relevance of the community-based HIV prevention services to the needs of transgender people; the key components of the most preferred ("ideal") HIV-prevention package for transgender people; ways to optimize the existing HIV prevention package for transgender people including enrollment and retention. Systematically collected data were analyzed and coded into the main domains, thematic categories and subcategories using thematic analysis. RESULTS The current HIV prevention programs were well-evaluated by the majority of respondents. Gender-affirming care was found to be the key need of transgender people. Integration of HIV prevention services and gender-affirming care was perceived as the main way to address the needs of transgender people. Internet-based and peer word-of-mouth recruitment may improve enrollment in services. Optimization of existing HIV prevention package may include: psychological counseling, referral and navigation to medical services, legal services, pre- and post-exposure prevention, dissemination of tube lubricants, femidoms and latex wipes, use of oral fluid test systems for HIV self-testing. CONCLUSIONS The findings of this study suggest potential solutions to improve community-based HIV prevention services for transgender people by introducing a transgender people -oriented package, which integrates gender transition, HIV prevention and other services. Provision of prevention services based on assessed risk and referral/navigation to related services are the key options for optimization of the existing HIV prevention package. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Oleksandr Neduzhko
- Ukrainian Institute on Public Health Policy, 5 Biloruska Str. Office 20, 27, Kyiv, 04050, Ukraine.
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Mayer TK, Becker-Hebly I, Elaut E, Heylens G, Kreukels BPC, Nieder TO. Desired decision-making role and treatment satisfaction among trans people during medical transition: results from the ENIGI follow-up study. J Sex Med 2023; 20:893-904. [PMID: 37037786 DOI: 10.1093/jsxmed/qdad039] [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: 10/11/2022] [Revised: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Shared decision making (SDM) is particularly important in transition-related medical interventions (TRMIs) given the nature of treatment and history of gatekeeping in transgender health care. Yet few studies have investigated trans people's desired decision-making role within TRMI and factors that influence these desires. AIMS The study investigated trans people's desired level of decision making during medical transition as well as possible sociodemographic predictors and correlations between decision-making desires and satisfaction with treatment. METHODS Data were collected from a clinical sample from 3 trans health care centers, as part of the larger ENIGI study. The data consisted of 568 trans individuals (60.2% assigned male at birth) 20 to 82 years of age (mean age = 38.58 years) who took part in the study 4 to 6 years after initial clinical contact. Binary logistic regressions were conducted to determine whether independent variables predicted group membership in decision-making role subgroups while a Spearman rank-order correlation was conducted to determine the relationship between desired decision-making involvement and satisfaction with care. OUTCOMES Main measures were desired decision-making role, satisfaction with treatment, age, education level, country of residence, treatment status, individual treatment progress score (ITPS), gender identity, and sex assigned at birth. RESULTS The vast majority of participants wanted to make medical decisions themselves. Age, education level, country of residence, treatment status, gender identity, and sex assigned at birth showed no significant effects in desired level of decision making, while the ITPS neared significance. Satisfaction with treatment was overall very high. For participants assigned male at birth, desire for a more active role in decision making was negatively correlated with satisfaction of labia surgery. CLINICAL IMPLICATIONS A desired decision-making role cannot be predicted based on the trans person's sociodemographic characteristics. More involvement from health professionals addressing medical information and education obligations may be needed when offering surgical construction of labia to individuals assigned male at birth. STRENGTHS AND LIMITATIONS This study builds on the few existing analyses of desired levels of decision-making role among trans people during transition. It is the first to investigate the role of education level and treatment status/ITPS on the desire of decision-making role. Gender identity and influence of nonbinary identity were not investigated for treatment satisfaction as these items were presented based on sex assigned at birth. CONCLUSION This study highlights that trans people in 3 European trans health care centers during medical transition desire a more active role in decision making. Satisfaction with treatment received was overall very high.
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Affiliation(s)
- Toby K Mayer
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Els Elaut
- Department of Experimental, Clinical and Health Psychology, Ghent University, 9000 Ghent, Oost-Vlaanderen, Belgium
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Gunter Heylens
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Timo O Nieder
- Interdisciplinary Transgender Health Care Center Hamburg, Department for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Uink B, Dodd J, Bennett S, Bonson D, Eades AM, Hill B. Confidence, practices and training needs of people working with Aboriginal and Torres Strait Islander LGBTIQ+ clients. CULTURE, HEALTH & SEXUALITY 2023; 25:206-222. [PMID: 35108157 DOI: 10.1080/13691058.2022.2031298] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Aboriginal and Torres Strait Islander LGBTIQ+ peoples face an elevated risk for poor health and social-emotional wellbeing, suggesting that this patient group are likely to attend health and community services. However, the current practices of those who deliver care to Aboriginal and Torres Strait Islander LGBTIQ+ peoples are unknown. Utilising mixed methods (survey; n = 197; focus groups and interviews; n = 56), we explored the current practices, confidence, knowledge, and training needs for working with Aboriginal LGBTIQ+ clients among Western Australian health and community service workers. Participants were predominately from the mental health and social-emotional wellbeing care sector. One-third of survey participants indicated that it was likely Aboriginal LGBTIQ+ peoples accessed their service. On average, participants reported high confidence and knowledge in working with Aboriginal LGBTIQ+ clients. Qualitative data indicated that staff struggled to accommodate what they understood to be the needs of clients who were both Aboriginal and/or Torres Strait Islander and LGBTIQ+, despite a willingness to 'get it right'. Findings provide the first-ever snapshot of inclusive practices among health and social support workers in Western Australia.
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Affiliation(s)
- Bep Uink
- Kulbardi Aboriginal Centre, PVC Education & Equity, Murdoch University, Perth, Western Australia, Australia
| | - Jenny Dodd
- Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Sian Bennett
- Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Dameyon Bonson
- Inclusive Practices Australia, Darwin, Northern Territory, Australia
| | - Anne-Marie Eades
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Braden Hill
- Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
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Valente PK, Paine EA, Mellman W, Rael CT, MacCrate C, Bockting WO. Positive patient-provider relationships among transgender and nonbinary individuals in New York City. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:247-262. [PMID: 37114109 PMCID: PMC10128430 DOI: 10.1080/26895269.2022.2136814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background: Transgender and nonbinary (TGNB) individuals have diverse health needs and may face disproportionate barriers to healthcare, including developing positive patient-provider relationships. While there is mounting evidence of gender-based stigma and discrimination in healthcare, little is known about how TGNB individuals develop positive patient-provider relationships. Aims: To examine TGNB individuals' interactions with healthcare providers and identify main characteristics of positive patient-providers relationships. Methods: We conducted semi-structured interviews with a purposive sample of 13 TGNB individuals in New York, NY. Interviews were transcribed verbatim and analyzed inductively for themes related to characteristics of positive and trusting relationships with healthcare providers. Results: Participants' mean age was 30 years (IQR = 13 years) and most participants were nonwhite (n = 12, 92%). Receiving peer referrals to specific clinics or providers helped many participants find providers perceived to be competent and created initial grounds for positive patient-provider relationships. Providers with whom participants had positive relationships commonly managed primary care and gender-affirming care and relied on a network of interdisciplinary providers for other specialized care. Providers who were positively evaluated were perceived to possess in-depth clinical knowledge on the issues they were responsible for managing, including gender-affirming interventions, particularly for TGNB patients who perceived themselves to be knowledgeable about TGNB-specific care. Provider and staff cultural competence and a TGNB-affirming clinic environment were also important, particularly early in the patient-provider relationship, and if combined with TGNB clinical competence. Discussion: Provider-focused training and education programs should combine components of TGNB clinical and cultural competence to facilitate development of positive relationships between TGNB patients and providers, thereby improving the health and wellbeing of TGNB people.
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Affiliation(s)
- Pablo K. Valente
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, Connecticut, USA
| | - Emily Allen Paine
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - William Mellman
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Christine T. Rael
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Caitlin MacCrate
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Walter O. Bockting
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
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A Content Analysis of Osteopaths’ Attitudes for a More Inclusive Clinical Practice towards Transgender People. Healthcare (Basel) 2022; 10:healthcare10030562. [PMID: 35327040 PMCID: PMC8953530 DOI: 10.3390/healthcare10030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/21/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives. The aim of this qualitative study was to explore the attitudes, beliefs, and preferences of Italian osteopaths regarding the management of transgender patients through a content analysis of emergent data from semi-structured interviews. Methods. This study was a content analysis based on the Standards for Reporting Qualitative Research guidelines. Purposive sampling of 10 Italian osteopaths was applied. Data were collected through semi-structured interviews, from March to April 2021, and subsequently transcribed verbatim with the content analysis carried out as an iterative process. Results. One participant was excluded during the first interview due to them being unsuitable for this study. Data saturation was reached after two interviews with the remaining nine participants. Data analysis revealed four main themes: microaggressions, acceptance and non-judgement, person-centered treatment, and education implementation. Conclusions. This study presents cisgender Italian osteopaths’ attitudes in the care of transgender people, revealing the desire to embrace and apply osteopathic tenets regardless of the patient’s gender identity.
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13
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Manzoor I, Khan ZH, Tariq R, Shahzad R. Health Problems & Barriers to Healthcare Services for the Transgender Community in Lahore, Pakistan. Pak J Med Sci 2022; 38:138-144. [PMID: 35035415 PMCID: PMC8713213 DOI: 10.12669/pjms.38.1.4375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/05/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To find out the major health problems and barriers in getting health care by transgender community in Lahore, Pakistan. Methods: An analytical cross-sectional study was conducted in transgender community of Lahore from January to October 2020. The study included 214 participants from different areas of Lahore by targeting their “gurus”. Non-probability, snow-ball sampling technique was used to collect required sample size. Data was collected by using a structured questionnaire. Data were analyzed using SPSS version 23. Results were generated in form of tables and graphs. Chi square test and Fischer’s exact test were used to find out associations between health seeking behavior with their transgender status and p value was fixed as ≤ 0.05 as significant. Results: Among total 214, 78.5% were transgender females and 21.5% were transgender male. Among the common health problems were depression (56%), anxiety (59%) and genital tract ulcers (45%). About 70% transgender seek health care from government hospitals. Among total 214 participants, 70% reported that they receive poor quality of health care. The main reasons of not getting proper care is non acceptance (20.7%), feeling ashamed (28.7%), non-availability of CNIC (44.5%) and un-affordability (6.1%). Significant association of transgender female with consultation with doctors (p=0.013), seeking care at government hospitals (p =0.038) poor experience at health care facility (0.050), neglect during medical treatment (p=0.015) and feeling of discrimination during treatment (p= 0.042). Conclusion: Transgender community face physical, mental, social and reproductive health issues. About 70% trans-genders receive poor quality of health care services. Non acceptance, feeling ashamed, non-availability of CNIC and non-affordability have been reported as major barriers in getting desired health care.
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Affiliation(s)
- Iram Manzoor
- Dr. Iram Manzoor, MBBS, FCPS, MSc, MCPS-HPE, PhD. Department of Community Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Zartasha Hanan Khan
- Dr. Zartasha Khan, MBBS, MCPS Trainee. Department of Community Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Rafia Tariq
- Dr. Rafia Tariq, 4 year MBBS student. Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Rijah Shahzad
- Dr. Rijah Shahzad, 4 year MBBS student. Akhtar Saeed Medical and Dental College, Lahore, Pakistan
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14
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Teti M, Bauerband LA, Myroniuk TW, Koegler E. Listening to Transgender Patients and Their Providers in Non-Metropolitan Spaces: Needs, Gaps, and Patient-Provider Discrepancies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10843. [PMID: 34682595 PMCID: PMC8535616 DOI: 10.3390/ijerph182010843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/26/2023]
Abstract
Trans and gender non-conforming (TGNC) patients need better care; providers need TGNC focused medical trainings. TGNC health conferences can help, yet these events occur mostly in urban centers. Meanwhile, patients in non-metropolitan areas often face significant discrimination and notably poor access to TGNC care. This study explores the ongoing needs of TGNC patients and their providers following a one-day TGNC health conference in a small town in the American Midwest. Exploratory semi-structured interviews were used to gather in-depth information from TGNC conference attendees (N = 25). Theme analysis methods were used to identify areas of need for future trainings. Providers reported that they needed more exposure to TGNC patients, judgement-free opportunities to learn the basics about TGNC care, and ongoing trainings integrated into their medical school and ongoing education credits. Patients needed better access to care, more informed providers, and safer clinics. They cited lack of specialty care (e.g., mental health, surgery) as particularly problematic in a non-metropolitan setting. TGNC patients, and their providers in non-metropolitan areas, urgently need support. Patients lack specialized care and often possess greater knowledge than their health care teams; providers, in these areas, lack opportunities to work with patients and stay up to date on treatments.
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Affiliation(s)
- Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA;
| | - L. A. Bauerband
- Department of Health Sciences, University of Missouri, Columbia, MO 65211, USA;
| | - Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA;
| | - Erica Koegler
- School of Social Work, University of Missouri-St. Louis, St. Louis, MO 63121, USA;
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15
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Kearns S, Kroll T, O‘Shea D, Neff K. Experiences of transgender and non-binary youth accessing gender-affirming care: A systematic review and meta-ethnography. PLoS One 2021; 16:e0257194. [PMID: 34506559 PMCID: PMC8432766 DOI: 10.1371/journal.pone.0257194] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths’ experiences accessing gender-affirming healthcare. Method A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908). Results Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled “The Rainbow Brick Road”. Conclusion This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker’s behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors’ conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.
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Affiliation(s)
- Seán Kearns
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
- * E-mail: ,
| | - Thilo Kroll
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Donal O‘Shea
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
- Department of Endocrinology and Diabetes Mellitus, St Vincent’s University Hospital, Dublin, Ireland
| | - Karl Neff
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
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16
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Noyola N, Sierra MJ, Allen DE, AhnAllen CG. Incorporating Administrative Staff in Trans-Affirmative Care Training: A Cognitive-Behavioral Learning Approach. Transgend Health 2021; 6:224-228. [PMID: 34414279 DOI: 10.1089/trgh.2020.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Administrative staff play an integral role in providing trans-affirmative health care. However, few trans-affirmative education and training interventions have been developed for non-medical health care staff. In this short report, we describe the development and piloting of a trans-affirmative care training intervention designed expressly for administrative staff. Based on our piloting, we put forth recommendations for the inclusion of administrative staff in trans-affirming education and training in health care systems. We hope to stimulate further development and evaluation of our approach, as well as changes in policies, so as to create more inclusive, trans-affirming health care systems.
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Affiliation(s)
- Néstor Noyola
- Department of Psychology, Clark University, Worcester, Massachusetts, USA.,Department of Psychiatry, Brigham and Women's Faulkner Hospital, Boston, Massachusetts, USA
| | | | - Donia E Allen
- Mass General Brigham, Somerville, Massachusetts, USA
| | - Christopher G AhnAllen
- Department of Psychiatry, Brigham and Women's Faulkner Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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17
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Abstract
BACKGROUND Transgender individuals can have complex health needs, in both trans and non-trans related health, experiencing higher levels of discrimination and disadvantages in accessing health care. The health needs of the transgender community are not consistent with the wider population, so individuals are often required to research services to meet their needs which can contribute to a reluctance in accessing health care. AIM To analyse existing literature on transgender patients experiences of health care. METHOD A search was performed of online databases (CINAHL, Medline, AMED, PubMed, ASSIA, PsychINFO, Web of Science and Scopus) and six studies were reviewed and analysed. FINDINGS Three main themes emerged: health professionals' knowledge and attitudes, navigating the system, and vulnerability and avoidance of health care. CONCLUSION The literature suggests that few encounters with health professionals were positive and that a lack of healthcare knowledge on trans-related issues and discrimination were the leading causes for dissatisfaction when accessing health services.
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Affiliation(s)
- Kirk Hobster
- Was a Staff Nurse, Critical Care, Nottingham University Hospital, at the time of writing. He is now a master of public health student, School of Medicine, University of Nottingham
| | - John McLuskey
- Associate Professor, School of Health Sciences, University of Nottingham
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18
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Kerr L, Jones T, Fisher CM. Alleviating gender dysphoria: A qualitative study of perspectives of trans and gender diverse people. J Health Serv Res Policy 2021; 27:4-13. [PMID: 33966466 DOI: 10.1177/13558196211013407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to explore perspectives of trans and gender diverse (TGD) people of ways to alleviate gender dysphoria in service provision and to develop a framework for application in health and other areas that can be used by researchers and service providers to design study protocols, assess organisations and enhance everyday practice in ways that are sensitive to TGD people's experiences. METHODS Data from a national Australian survey on TGD people conducted in 2018-2019 (n = 340) were used to develop a framework for alleviating dysphoria. Participants were asked an open-ended question on ways that body discomfort could be minimised in clinical encounters. Inductive thematic analysis was used to develop themes true to participant sentiment, which formed the basis for the development of a framework. RESULTS The sample was overall young, with 60.6% aged 18-24, and a strong representation of gender diverse people (42.6%). The most important theme for participants was the context of the experience, which included the subthemes of the interpersonal qualities of service providers, language and pronouns, and practical aspects. Aspects of systems were also important, with education and awareness being particularly emphasised, followed by inclusive environments. Access to gender affirming medical and surgical procedures was rarely mentioned (2.6%). A minority of participants indicated that there was nothing that could be done to alleviate their gender dysphoria (4.4%). CONCLUSIONS The study proposes a framework that can help facilitate assessment of a service's current practices, inform a practitioner's daily practice and be used by researchers to appropriately design studies. The most important areas to address centre on the context of the immediate experience, which may be influenced through systems-level characteristics.
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Affiliation(s)
- Lucille Kerr
- PhD Graduate, Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Tiffany Jones
- Associate Professor, School of Educational Studies, Macquarie University, Australia
| | - Christopher M Fisher
- Associate Professor, Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
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19
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Ferrucci KA, Walubita T, Beccia AL, Ding EY, Jesdale BM, Lapane KL, Streed CG. Health Care Satisfaction in Relation to Gender Identity: Behavioral Risk Factor Surveillance Survey, 20 States (2014-2018). Med Care 2021; 59:312-318. [PMID: 33492048 PMCID: PMC9260670 DOI: 10.1097/mlr.0000000000001508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care satisfaction is a key component of patient-centered care. Prior research on transgender populations has been based on convenience samples, and/or grouped all gender minorities into a single category. OBJECTIVE The objective of this study was to quantify differences in health care satisfaction among transgender men, transgender women, gender nonconforming, and cisgender adults in a diverse multistate sample. RESEARCH DESIGN Cross-sectional analysis of 2014-2018 Behavioral Risk Factor Surveillance System data from 20 states, using multivariable logistic models. SUBJECTS We identified 167,468 transgender men, transgender women, gender-nonconforming people, cisgender women, and cisgender men and compared past year health care satisfaction across these groups. RESULTS Transgender men and women had the highest prevalence of being "not at all satisfied" with the health care they received (14.6% and 8.6%, respectively), and gender-nonconforming people had the lowest prevalence of being "very satisfied" with their health care (55.7%). After adjustment for sociodemographic characteristics, transgender men were more likely to report being "not at all satisfied" with health care than cisgender men (odds ratio: 4.45, 95% confidence interval: 1.72-11.5) and cisgender women (odds ratio: 3.40, 95% confidence interval: 1.31-8.80). CONCLUSIONS Findings indicate that transgender and gender-nonconforming adults report considerably less health care satisfaction relative to their cisgender peers. Interventions to address factors driving these differences are needed.
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Affiliation(s)
- Katarina A Ferrucci
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Tubanji Walubita
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Ariel L Beccia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Eric Y Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Carl G Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine
- Center for Transgender Medicine & Surgery, Boston Medical Center, Boston, MA
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20
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MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:339-361. [PMID: 33206200 DOI: 10.1007/s00127-020-01976-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
Worldwide, growing concern with young people's mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11-30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes-initiating contact with mental health services; characteristics of services' response; and youths' and carers' appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths' pathways to them. It underlines the need for grounding reform in youths' and carers' perspectives and needs.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, Canada. .,Douglas Research Centre, Montreal, Canada. .,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada.
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
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21
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Nieder TO, Mayer TK, Hinz S, Fahrenkrug S, Herrmann L, Becker-Hebly I. Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Youth With Gender Dysphoria: A Prospective Clinical Cohort Study. J Sex Med 2021; 18:632-645. [PMID: 33642235 DOI: 10.1016/j.jsxm.2020.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/26/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of adolescents presenting with gender dysphoria (GD) in healthcare services has increased significantly, yet specialized services offering transition-related care (TRC) for trans youth is lacking. AIM To investigate satisfaction with TRC, regret, and reasons for (dis)satisfaction with transition-related medical interventions (TRMIs) in trans adolescents who had presented to the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS). METHODS Data were collected from a clinical cohort sample of 75 adolescents and young adults diagnosed with GD (81% assigned female at birth) aged 11 to 21 years (M = 17.4) at baseline and follow-up (on a spectrum of ongoing care, on average 2 years after initial consultation). To determine progress of the youth's medical transitions, an individual treatment progress score (ITPS) was calculated based on number of desired vs received TRMIs. OUTCOMES Main outcome measures were satisfaction with TRC at the time of follow-up, ITPS, social support, reasons for regret and termination of TRC, and (dis)satisfaction with TRMIs. RESULTS Participants underwent different stages of TRMIs, such as gender-affirming hormone treatment or surgeries, and showed overall high satisfaction with TRC received at the Hamburg GIS. Regression analysis indicated that a higher ITPS (an advanced transition treatment stage) was predictive of higher satisfaction with TRC. Sex assigned at birth, age, and time since initial consultation at the clinic showed no significant effects for satisfaction with TRC, while degree of social support showed a trend. No adolescents regretted undergoing treatment at follow-up. Additional analysis of free-text answers highlighted satisfaction mostly with the physical results of TRMI. CLINICAL IMPLICATIONS Because youth were more satisfied with TRC when their individual transition (ITPS) was more progressed, treatment should start in a timely manner to avoid distress from puberty or long waiting lists. STRENGTHS AND LIMITATIONS This study is one of the first to report on treatment satisfaction among youth with GD from Europe. The ITPS allowed for a more detailed evaluation of TRMI wishes and experiences in relation to satisfaction with TRC and may close a gap in research on these treatments in adolescent populations. However, all participants were from the same clinic, and strict treatment eligibility criteria may have excluded certain trans adolescents from the study. Low identification rates with non-binary identities prevented comparisons between non-binary and binary genders. CONCLUSION The study highlights the role of TRMI and individual treatment or transition progress for youth's overall high satisfaction with TRC received at the Hamburg GIS. Nieder TO, Mayer TK, Hinz S, et al. Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Youth With Gender Dysphoria: A Prospective Clinical Cohort Study. J Sex Med 2021;18:632-645.
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Affiliation(s)
- T O Nieder
- Institute For Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T K Mayer
- Institute For Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Hinz
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Fahrenkrug
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Herrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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22
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Parra N, Patete C, Tarsha A, Fein LA. Transgender patients’ satisfaction with their mental health providers prior to gender affirming surgery. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021. [DOI: 10.1080/19359705.2020.1793868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Natalia Parra
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carissa Patete
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amir Tarsha
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lydia A. Fein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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23
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Carlström R, Ek S, Gabrielsson S. 'Treat me with respect': transgender persons' experiences of encounters with healthcare staff. Scand J Caring Sci 2020; 35:600-607. [PMID: 33128475 DOI: 10.1111/scs.12876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transgender persons face barriers to health care including discrimination and lack of awareness by professionals. This study aimed to describe transgender persons' experiences of encounters with healthcare staff. METHODS Participants were recruited through postings in social media and on websites targeting people identifying as transgender. Through an online form, 21 people identifying as transgender provided written self-reports. These were analysed using a method for inductive qualitative content analysis. The study was conducted in Sweden in 2018. RESULTS The results describe transgender persons' experiences and perceptions of encounters with healthcare staff in one theme: treat me with respect, and three main categories: accept me for who I am; treat me according to my needs; and meet me with competence. CONCLUSIONS Healthcare professionals can contribute in restoring and upholding transgender people's trust in health care by accepting their identity and focusing on their healthcare needs while also being informed about transgender people's needs and realities. A key point in this is recognising transgender person's vulnerability to violations of dignity in relation to health care.
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Affiliation(s)
- Rebeccah Carlström
- Psychiatric Outpatient Clinic, Örnsköldsvik Hospital, Örnsköldsvik, Sweden
| | - Susanna Ek
- Psychiatric Emergency Department, Vrinnevi Hospital, Region Östergötland, Norrköping, Sweden
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24
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Williams D, Dodge B, Berger B, Kimbrough A, Bostwick WB. Self-Reported Health Concerns and Healthcare Experiences among Diverse Bisexual Men: An Exploratory Qualitative Study. JOURNAL OF BISEXUALITY 2020; 20:301-323. [PMID: 34733119 PMCID: PMC8562778 DOI: 10.1080/15299716.2020.1822256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bisexual individuals have disproportionately higher rates of physical and mental health concerns compared to both heterosexual and gay/lesbian individuals. Few studies have examined diverse bisexual-identified men's perceived health concerns for themselves and other bisexual men or their experiences in healthcare settings. This qualitative study explored health and healthcare experiences among cisgender and transgender bisexual men, most of whom were also men of color. Data were collected through semi-structured interviews. Participants included 31 self-identified bisexual men from the Chicago area. Participants were asked questions surrounding bisexual men's health and healthcare experiences in general and their personal experiences, drawing connections between intersecting bisexual and racial/ethnic identities. Interview transcripts were analyzed using thematic analysis. Participants reported sexual health and mental health as the top health concerns for bisexual men. Participants viewed their bisexual identity as a motivator for seeking healthcare services and adopting safer sex practices. Mental health challenges faced by respondents were connected to bisexual stereotypes and fear of disclosing bisexual and transgender identities. Furthermore, perceptions of masculinity amongst bisexual men of color were particularly salient in connecting to their mental health experiences. The intersection of participants' transgender and bisexual identities impacted their healthcare experiences in general healthcare settings, with many participants reporting a lack of cultural competence and provider knowledge concerning their identities. LGBTQ Federally Qualified Health Centers, however, were described as providing compassionate care. Our findings suggest the need for more interventions that account for bisexual men's intersecting identities. Furthermore, increased provider training is necessary for providing affirmative care to bisexual men.
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Affiliation(s)
- Deana Williams
- School of Public Health, Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
| | - Brian Dodge
- School of Public Health, Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
| | - Bria Berger
- School of Nursing, Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alex Kimbrough
- School of Nursing, Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Wendy B. Bostwick
- School of Nursing, Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, Illinois, USA
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25
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Hendrickson SG, Contreras CV, Schiller E, Walsh D. Exploring health care experiences of transgender people living in Texas. Nurs Outlook 2020; 68:476-483. [DOI: 10.1016/j.outlook.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
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Mulqueeny DM, Nkabini SM, Mashamba-Thompson TP. School-going transgender youths' experiences at health care facilities: a systematic scoping review protocol. Syst Rev 2020; 9:90. [PMID: 32331529 PMCID: PMC7181503 DOI: 10.1186/s13643-020-01347-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Globally, miniscule improvements have been implemented regarding equality, inclusion, access, and protection of people with diverse gender identities whilst accessing health care facilities of which transgender youth form part. Literature has highlighted that the care transgender youth receive at health care facilities can result in positive or negative outcomes. School-going transgender youth constitute a unique group whose experiences at health care facilities warrant ongoing research. Hence, the objective of this scoping review is to systematically map evidence of school-going transgender youths' experiences at health care facilities regarding service delivery, support, and policies and to identify literature gaps that could inform future research. METHODS We will conduct a scoping review, using peer-reviewed journal articles that present literature on school-going transgender youths' experiences at health care facilities. Searches for relevant articles will be conducted on the following databases: PubMed, Cochrane Library, Campbell collaboration, Scopus, Embase, and MEDLINE. Additional searches will be conducted on institutional websites or web-based search portals. Two reviewers will independently extract data from all relevant search engines incorporating the study objective, research questions, and eligibility criteria. The inclusion criteria include published full-text qualitative, quantitative, and mixed-method studies that address the topic with no language and publication year limitations to reflect a comprehensive range of literature that includes the implementation of the SDGs. All literature that does not meet the inclusion criteria will be excluded. The quality of included studies will be appraised using the mixed methods appraisal tool (MMAT) - version 2018. DISCUSSION We anticipate mapping the experiences of school-going transgender youth at health care facilities. Once summarized, the data could be useful to clinical educators, health workers, policy makers, and guide future research to ensure that the human and patients' rights of transgender youth, are globally acknowledged, protected, and respected within health care facilities.
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Affiliation(s)
- Delarise M. Mulqueeny
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Pinetown, South Africa
- Department of Social Science, Gender and Education, School of Education, University of KwaZulu-Natal, Room 01-032, 121 Marianhill Rd, Pinetown, 3605 South Africa
| | - Senzelokuhle M. Nkabini
- Department of Social Science, Gender and Education, School of Education, University of KwaZulu-Natal, Room 01-032, 121 Marianhill Rd, Pinetown, 3605 South Africa
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Pinetown, South Africa
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Banerjee D, Rao TSS. "The Graying Minority": Lived Experiences and Psychosocial Challenges of Older Transgender Adults During the COVID-19 Pandemic in India, A Qualitative Exploration. Front Psychiatry 2020; 11:604472. [PMID: 33488427 PMCID: PMC7820119 DOI: 10.3389/fpsyt.2020.604472] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background: The Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. Certain factors like age, an immunocompromised state, and social impoverishment, etc. can add to health vulnerabilities during this pandemic. One such group is older transgender adults, who often bear a combination of these risks. As the world is aging fast, their numbers have also been increasing. With this in mind, this study explores the lived experiences and psychosocial challenges of older transgender adults during the COVID-19 pandemic in India. Methods: A qualitative approach was used. Ten individuals with "transgender" identity above the age of 60 were recruited with consent through purposive sampling. In-depth interviews were conducted on the telephone using a pre-designed interview schedule. They were recorded, translated, and transcribed verbatim. Hasse's adaptation of Colaizzi's phenomenological method was used for analysis. Independent coding and respondent validation were used to ensure the rigor of data. Results: The super-arching categories (with themes) were marginalization ("second" priority, stigma, social disconnection), the dual burden of "age" and "gender" (ageism, othering, and psychosexual difficulties), and multi-faceted survival threats (physical, emotional, financial) during the pandemic. Social rituals, spirituality, hope, and acceptance of "gender dissonance" emerged as the main coping factors, whereas their unmet needs were social inclusion, awareness related to COVID-19, mental health care, and audience to their distress. Conclusion: The elderly gender minorities are at increased emotional and social risks during the ongoing pandemic, and their voices are mostly unheard. The need for policy implementation and community awareness about their social welfare is vital to improving their health and well-being.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - T S Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
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How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons. J Clin Med 2019; 8:jcm8050749. [PMID: 31130679 PMCID: PMC6572165 DOI: 10.3390/jcm8050749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 11/17/2022] Open
Abstract
The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.
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Abstract
Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom. This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology. We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care. We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services. There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.
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Affiliation(s)
- Rusi Jaspal
- Faculty of Health & Life Sciences, De Montfort University, Leicester, United Kingdom.,Minority Research Profile, Åbo Akademi University, Turku, Finland
| | - Lauren Kennedy
- Faculty of Health & Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Shema Tariq
- Centre for Clinical Research in Infection and Sexual Health, University College London, London, United Kingdom
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Knutson D, Martyr MA, Mitchell TA, Arthur T, Koch JM. Recommendations from Transgender Healthcare Consumers in Rural Areas. Transgend Health 2018; 3:109-117. [PMID: 29915810 PMCID: PMC6004081 DOI: 10.1089/trgh.2017.0052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Scholars indicate that rates of mental and physical health issues (e.g., substance use, anxiety, depression) may be much higher among transgender individuals relative to the general population. This disparity may be even greater for transgender individuals in rural areas. Clinical researchers suggest using affirmative therapeutic approaches and interventions to address the health concerns of transgender individuals, specifically to connect individuals with the transgender community. However, little is known about the content of information that is shared in transgender communities in rural areas. Method: For this qualitative study, researchers asked transgender individuals in rural areas (n=10) what recommendations they would offer to other transgender individuals in rural areas regarding healthcare access. Results: Results were organized into four domains: Access care, Quality control, Difficulties, and Mentorship. Within these domains, we identified 11 sub-domains: Get physical healthcare, Get mental healthcare, Provider search, Provider vetting, Treatment verification, It will be difficult, Know who you are, Believe in yourself, Move, Connect to community, and Other. Conclusions: We discuss implications of our findings for healthcare provision in rural areas, and we provide recommendations for future research.
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Affiliation(s)
- Douglas Knutson
- Department of Psychology, Southern Illinois University at Carbondale, Carbondale, Illinois
| | - Meredith A Martyr
- Department of Educational Psychology, University of Minnesota, Twin Cities, Minneapolis, Minnesota
| | - Travis A Mitchell
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Tori Arthur
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Julie M Koch
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
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Valenta T, Shade K, Lieggi M. Experiences of transgender individuals when accessing health care: a qualitative systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:628-634. [PMID: 29521862 DOI: 10.11124/jbisrir-2017-003438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The objective is to synthesize existing qualitative literature examining the experiences of transgender individuals when accessing health care.
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Affiliation(s)
- Tamera Valenta
- Samuel Merritt University, School of Nursing, Oakland, USA
| | - Kate Shade
- Samuel Merritt University, School of Nursing, Oakland, USA
- UCSF Center for Evidence Synthesis & Implementation: a Joanna Briggs Institute Center of Excellence
| | - Michelle Lieggi
- UCSF Center for Evidence Synthesis & Implementation: a Joanna Briggs Institute Center of Excellence
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