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Kiely E, Millet N, Baron A, Kreukels BPC, Doyle DM. Unequal geographies of gender-affirming care: A comparative typology of trans-specific healthcare systems across Europe. Soc Sci Med 2024; 356:117145. [PMID: 39067377 DOI: 10.1016/j.socscimed.2024.117145] [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: 08/31/2023] [Revised: 06/09/2024] [Accepted: 06/15/2024] [Indexed: 07/30/2024]
Abstract
RATIONALE Gender-affirming healthcare can carry significant benefits for trans people. However, there are substantial geographical inequalities in the provision of and access to trans-specific healthcare across Europe. Comparative healthcare systems research has typically focused on universal services, neglecting provision which serves specific groups within populations (e.g., trans people). OBJECTIVE This study aimed to develop a comparative typology of trans-specific healthcare systems across 28 European countries (the EU 27 plus the UK), and to examine country-level correlates which may influence or be influenced by these systems. METHODS Using hierarchical and k-means cluster analysis, countries were classified into four types based on measures of trans-specific healthcare provision, regulation and access. Possible country-level correlates (including socio-political climate, medical outcomes, and the general healthcare system) were investigated. RESULTS AND DISCUSSION The cluster analysis identified four clusters of trans-specific healthcare systems in Europe, characterized as: 1) Centralized conservative (highly centralized, extensive range of treatments, few trans-specific government policies); 2) Centralized reformist (highly centralized, extensive range of treatments, multiple trans-specific government policies); 3) Decentralized marketized (highly decentralized, moderate range of treatments, few trans-specific government policies); 4) Underdeveloped (highly decentralized, limited range of treatments, few or no trans-specific government policies). We found statistically significant differences between the clusters in rates of: public support for trans people; gender identity concealment; treatment access; overall health expenditure; gender inequality. CONCLUSIONS The study develops a novel typology of trans-specific healthcare systems in Europe. It also identifies a range of potential drivers and outcomes of geographical divergences and inequalities in trans-specific healthcare provision. Building on this typology, future comparative research should aim to link the structure of healthcare systems to outcomes for trans people. Comparative healthcare systems research must account for the distinctive forms taken by services and systems that provide healthcare to specific groups within populations.
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Affiliation(s)
- Ed Kiely
- Department of Medical Psychology, Amsterdam UMC, the Netherlands; Department of Geography, University of Cambridge, United Kingdom
| | - Nessa Millet
- Department of Medical Psychology, Amsterdam UMC, the Netherlands
| | - Asher Baron
- Department of Sociology, Columbia University, New York, NY, 10027, USA
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DeMaio DM, Barerra EP, Post J, Boskey ER, Guss CE. Understanding Gaps of HIV Knowledge Among Transgender Young Adults: A Pilot Interview Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:229-243. [PMID: 39189961 DOI: 10.1521/aeap.2024.36.4.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Many transgender young adults are unaware of the role of pre-exposure prophylaxis (PrEP) in HIV prevention. Our aim was to understand where transgender and gender-diverse young adults receive health information about HIV and PrEP and their preferences for future learning. Semistructured, qualitative individual and group interviews were done with 14 transgender and gender-diverse young adults. Interviews were transcribed verbatim and analyzed using thematic analysis. Four themes emerged from the interviews related to (1) making trustworthy education materials, (2) the importance of communities, (3) knowledge needed about PrEP, and (4) a lack of early and diverse classroom education. Transgender and genderdiverse persons are at higher risk for HIV than their cisgender peers, yet they have information gaps and hold misconceptions about preventative measures like PrEP. Such misconceptions may be addressed by early, inclusive conversations about HIV transmission and prevention.
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Affiliation(s)
- Danielle M DeMaio
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - Ellis P Barerra
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - Julian Post
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - Elizabeth R Boskey
- Division of Gynecology, Boston Children's Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Harvard Medical School
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Casas-Ramírez M, Martínez-Linares JM, Cortés-Martín JJ, López-Entrambasaguas OM. Trans people perceptions of care received from healthcare professionals - A phenomenological study. Heliyon 2024; 10:e23328. [PMID: 38163130 PMCID: PMC10755318 DOI: 10.1016/j.heliyon.2023.e23328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Trans people have unique health needs and turn to the public health system to meet them. Offering them a more inclusive assistance requires health professionals to know these needs and work on cultural competence. Understanding trans people perceptions of service received will improve therapeutic relationships and the assistance provided to them. Objective To understand trans patients experiences with health care and their perception of care rendered by the Andalusian Public Health System. Design A qualitative phenomenological study according to Ricoeur's hermeneutic approach. Methodology 18 in-depth interviews were conducted between January and April 2022 with trans adult users of the Andalusian Public Health System. These interviews were audio recorded, transcribed and analyzed following the steps proposed by Tan. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study report. Results Three themes were generated from trans patients experiences in the Andalusian Public Health System related to the assistance provided to them: 1) Positive and negative feelings during their pass through the public health system, 2) The importance of being able to receive the care they need, and 3) Having the chosen identity in official documents in order to utterly complete their transition. Conclusion Care rendered by healthcare professionals to trans people was received as positive in mostly cases. However, trans people think these professionals need more training in order to avoid some behaviors they perceive as discriminatory and which they believe tends to pathologize gender identity. They also require more information about the treatments in particular they are about to receive and they demand to end drug shortages. Administrative procedures to change identity are also problematic. So the healthcare system must undergo some modifications in order to become more inclusive.
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Villemure SE, Furlotte K, Richard G, Wilby KJ. Raising voices of 2SLGBTQIA+ patients: The intersection of minority stress and systemic oppression in pharmacy practice. J Am Pharm Assoc (2003) 2023; 63:1112-1119. [PMID: 37207712 DOI: 10.1016/j.japh.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/01/2023] [Accepted: 05/08/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Two-spirit, lesbian, gay, bisexual, trans, queer, intersex, asexual, and other sex, sexual, and gender identities (2SLGBTQIA+) experience minority stress processes in pharmacy settings. Processes may be distal (objective prejudicial events) or proximal (subjective internalized feelings) and lead to delay or avoidance of care. The nature of these experiences in pharmacies and ways to reduce occurrence is largely unknown. OBJECTIVES This study aimed to characterize 2SLGBTQIA+ individuals' perceived experiences in pharmacies according to the minority stress model (MSM) and to elicit patient-identified individual, interpersonal, and systemic strategies for reducing systemic oppression of 2SLGBTQIA+ individuals in pharmacy practice. METHODS This was a qualitative phenomenological study using semistructured interviews. Thirty-one 2SLGBTQIA+ individuals from the Canadian Maritime provinces completed the study. Transcripts were coded according to domains of the MSM (distal and proximal processes) and the lens of systemic oppression (LOSO) (individual, interpersonal, and systemic factors). Framework analysis was used to identify themes within each theoretical domain. RESULTS Distal and proximal minority stress processes were described by 2SLGBTQIA+ individuals in pharmacy settings. Distal processes included direct and indirect perceived discrimination and microaggressions. Proximal processes included expectation of rejection, concealment, and internalized self-stigma. Nine themes were identified according to the LOSO. Two related to the individual (knowledge and abilities, respect), 2 related to interpersonal relations (rapport and trust, holistic care), and 5 related to systemic factors (policies and procedures, representation and symbols, training/specialization, environment/privacy, technology). CONCLUSION Findings support the notion that individual, interpersonal, and systemic strategies can be implemented to reduce or prevent minority stress processes from occurring in pharmacy practice. Future studies should evaluate these strategies to better understand effective ways to improve inclusivity for 2SLGBTQIA+ people in pharmacy settings.
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Huttunen A. “I had to teach my own doctor what this was about”: Information sharing barriers and information evaluation of Finnish transgender people. LIBRARY & INFORMATION SCIENCE RESEARCH 2023. [DOI: 10.1016/j.lisr.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Kitzie V, Smithwick J, Blanco C, Green MG, Covington-Kolb S. Co-creation of a training for community health workers to enhance skills in serving LGBTQIA+ communities. Front Public Health 2023; 11:1046563. [PMID: 37006528 PMCID: PMC10060788 DOI: 10.3389/fpubh.2023.1046563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
This paper describes creating and implementing a 30-h LGBTQIA+ specialty training for community health workers (CHWs). The training was co-developed by CHW training facilitators (themselves CHWs), researchers with expertise in LGBTQIA+ populations and health information, and a cohort of 11 LGBTQIA+ CHWs who theater tested and piloted the course. The research and training team collected cohort feedback through focus groups and an evaluative survey. Findings stress the importance of a curriculum designed to elicit lived experiences and informed by a pedagogical framework centered on achieving LGBTQIA+ visibilities. This training is a vital tool for CHWs to foster cultural humility for LGBTQIA+ populations and identify opportunities to support their health promotion, especially considering their limited and sometimes absent access to affirming and preventative healthcare. Future directions include revising the training content based on cohort feedback and adapting it to other contexts, such as cultural humility training for medical and nursing professionals and staff.
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Affiliation(s)
- Vanessa Kitzie
- School of Information Science, University of South Carolina, Columbia, SC, United States
- *Correspondence: Vanessa Kitzie
| | - Julie Smithwick
- Center for Community Health Alignment, University of South Carolina Arnold School of Public Health, Columbia, SC, United States
| | - Carmen Blanco
- Center for Community Health Alignment, University of South Carolina Arnold School of Public Health, Columbia, SC, United States
| | - M. Greg Green
- Center for Community Health Alignment, University of South Carolina Arnold School of Public Health, Columbia, SC, United States
| | - Sarah Covington-Kolb
- Center for Community Health Alignment, University of South Carolina Arnold School of Public Health, Columbia, SC, United States
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Wagner TL, Marsh D, Curliss L. Theories and implications for centering indigenous and queer embodiment within sociotechnical systems. J Assoc Inf Sci Technol 2023. [DOI: 10.1002/asi.24746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Travis L. Wagner
- College of Information Studies The University of Maryland College Park Maryland USA
| | - Diana Marsh
- College of Information Studies The University of Maryland College Park Maryland USA
| | - Lydia Curliss
- College of Information Studies The University of Maryland College Park Maryland USA
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Apodaca C, Casanova-Perez R, Bascom E, Mohanraj D, Lane C, Vidyarthi D, Beneteau E, Sabin J, Pratt W, Weibel N, Hartzler AL. Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out. J Am Med Inform Assoc 2022; 29:2075-2082. [PMID: 35985279 PMCID: PMC9667158 DOI: 10.1093/jamia/ocac142] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient-provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity. MATERIALS AND METHODS We interviewed 25 BIPOC and/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants' immediate reactions and longer-term consequences of those experiences. RESULTS We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions. DISCUSSION By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out.To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare. CONCLUSIONS BIPOC and LGBTQ+ patients' perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.
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Affiliation(s)
- Calvin Apodaca
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Reggie Casanova-Perez
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Emily Bascom
- Information School, University of Washington, Seattle, Washington, USA
| | - Deepthi Mohanraj
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Cezanne Lane
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Drishti Vidyarthi
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - Erin Beneteau
- Information School, University of Washington, Seattle, Washington, USA
| | - Janice Sabin
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Nadir Weibel
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
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Lookingbill V. Examining nonsuicidal self-injury content creation on TikTok through qualitative content analysis. LIBRARY & INFORMATION SCIENCE RESEARCH 2022. [DOI: 10.1016/j.lisr.2022.101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Boland MR, Elhadad N, Pratt W. Informatics for sex- and gender-related health: understanding the problems, developing new methods, and designing new solutions. J Am Med Inform Assoc 2022; 29:225-229. [PMID: 35024858 PMCID: PMC8757304 DOI: 10.1093/jamia/ocab287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 01/14/2023] Open
Affiliation(s)
- Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Noémie Elhadad
- Biomedical Informatics, Columbia University, New York, New York, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
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