'That would have been beneficial': LGBTQ education for home-care service providers

Barriers to Healthcare for Transgender Individuals

Background: Transgender (TG) clients experience provider bias, erasure, refusal to treat, and violence. Objective: The purpose of this article is to identify barriers to healthcare for TG individuals and discuss recommendations for providers treating this population. Methods: Literature review of prime research was conducted using the Whittemore and Knafl methodology (2005). Results: Evidence suggests that barriers to TG healthcare include lack of provider TG knowledge and trans sensitivity, lack of provider communication, and lack of emotional and physical safe healthcare environments. Conclusions: TG clients face barriers to accessing healthcare, and specific recommendations to improve provider practice will decrease these barriers. Implications for Practice: Lack of provider education affects TG individuals accessing quality healthcare. Recommendations to improve provider practice are essential to improve care.

Effectiveness of Harm Reduction Interventions in Chemsex: A Systematic Review

The phenomenon of chemsex has emerged as an essential public health issue in recent years. This systematic review aimed to investigate currently available harm reduction strategies and to evaluate the efficacy of the corresponding interventions.

METHODS

A systematic review of the scientific literature related to harm and risk reduction strategies and the effectiveness of chemsex interventions. Between January 2024 and May 2024, the articles were retrieved from the electronic databases Pubmed, Web of Science, Scopus, PsycInfo, Cochrane, Dialnet, CUIDEN, and SciELO. The review protocol was registered in the PROSPERO database (registration number CRD42024508953). The inclusion criteria were as follows: (I) original studies published in peer-reviewed journals, (II) studies exploring harm reduction interventions for chemsex, and (III) studies reflecting the efficacy of harm reduction interventions for chemsex. Two reviewers independently selected articles by title, abstract, and full paper review and extracted data. Two authors described the selected studies and assessed their methodological quality.

RESULTS

The systematic review comprised six scientific papers that met the selection criteria and were obtained from five countries. Although a limited number of studies were included, it was observed that they presented a medium-high methodological quality. Programs evaluated interventions to reduce harm from chemsex, such as a web-based intervention that improved self-efficacy to refuse risky behaviors and accept HIV testing. The studies suggested that peer-led programs can be effective, especially with facilitators who have experienced chemsex dependence.

CONCLUSION

Harm reduction strategies in chemsex are effective and should be promoted by health professionals. Interventions should be accessible, personalized, and non-judgmental to provide appropriate care and support, ensuring a comprehensive and effective public health response.

LGBTQ+ Inclusivity Training and Education: A Toolkit for Skilled Nursing Facilities

OBJECTIVES

The objective of this study was to develop the LGBTQ+ Inclusivity Training and Education (LITE) toolkit and to examine the usability and acceptability of the LITE toolkit to health care workers and staff who work within skilled nursing facilities (SNFs).

DESIGN

A community-engaged approach using human-centered design to develop the LITE toolkit. To test the usability and acceptability of the LITE toolkit, we provided a posttest survey to users after a 9-week period.

SETTING AND PARTICIPANTS

The LITE toolkit was distributed to 25 SNFs throughout a 7-county area in North Carolina.

METHODS

Development processes included an LGBTQ+ community advisory board, development of resource topics and a list of best practices, and development of a website. The LITE toolkit comprised a website of LGBTQ+ resources, poster of 6 Best Practices to LGBTQ+ Care, rainbow lapel pins, and writing pens with the LITE logo. Online surveys were distributed to SNF administrators to share with health care workers and staff to collect data on the usability and acceptability of the LITE toolkit. Descriptive statistics were used for data analysis.

RESULTS

Fifteen participants completed the survey. Answering all survey questions was not a requirement. Seventy-nine percent (n = 14) of SNF health care workers indicated that the LITE toolkit was "easy to understand" and that they were satisfied with the contents. Fifty-three percent (n = 15) responded that the LITE toolkit would improve the way they care for patients. Sixty-six percent (n = 15) of health care workers and staff strongly agreed the LITE toolkit was applicable to their job role.

CONCLUSIONS AND IMPLICATIONS

Providing useful and acceptable LGBTQ+-focused training and education for members of the SNF community addresses the need for health care worker and staff training to foster equitable care and inclusive environments for the LGBTQ+ older adult community. Additional work focused on understanding the facilitators and barriers to using the LITE toolkit in the SNF setting is needed.

LGBTQ+ Healthcare Teaching in UK Medical Schools: An Investigation into Medical Students' Understanding and Preparedness for Practice

OBJECTIVES

Lesbian, gay, bisexual, trans* and queer/questioning + (LGBTQ+) healthcare teaching within UK medical schools is currently lacking, potentially impacting on patients' confidence in health services and ability to access care. The current study conducted a multi-site analysis aiming to investigate medical students' perceptions towards the teaching of LGBTQ+ healthcare in UK medical schools, as well as to gain a greater understanding of medical students' level of knowledge of LGBTQ+ healthcare, and preparedness for working with LGBTQ+ patients.

METHODS

Medical students (N = 296) from 28 UK institutions responded to a 15-question online survey distributed via course leads and social media. Thematic analysis of qualitative data was conducted, as well as statistical analysis of quantitative data using SPSS.

RESULTS

Only 40.9% of students reported having any teaching on LGBTQ+ healthcare, 96.6% of whom said this was one-off or very irregular sessions. Only 1 in 8 felt their knowledge and skills on LGBTQ+ healthcare was sufficient. 97.2% of students questioned wanted more knowledge on LGBTQ+ healthcare.

CONCLUSION

The current study highlighted that UK medical students felt underprepared for working with LGBTQ+ patients due to insufficient education. Given that teaching on LGBTQ+ healthcare is often optional and extra-curricular, it may not be reaching those who need it most. The authors are calling for the mandatory inclusion of LGBTQ+ healthcare in the teaching of all UK medical schools, within their individual curriculum frameworks, and with regulatory support from the General Medical Council. This will ensure a wider understanding among medical students, and subsequently qualified doctors, of the health inequities and unique health issues LGBTQ+ people face, which will better equip them to provide high-quality care to LGBTQ+ patients, and start to tackle the inequities they face.

Disparities and resilience: analyzing online Health information provision, behaviors and needs of LBGTQ + elders during COVID-19

BACKGROUND

Prior studies indicate that older members of LGBTQ+ communities have specific health provision and health information needs related to coping with COVID-19, its long-term effects, and the social and economic impact of the pandemic. This study addresses the issue of a lack of timely, complete, and high-quality data about this population's healthcare and healthcare information needs and behaviors. Recognizing also that this is a diverse population made up of multiple communities and identities with different concerns and experiences, this research seeks to develop and refine a method that can provide additional nuanced data and insights that can support improved and more closely targeted health interventions and online information provision.

METHODS

We use computational discourse analysis, which is based on NLP algorithms, to build and analyze a digital corpus of online search results containing rich, wide-ranging content such as quotes and anecdotes from older members of LGBTQ+ communities as well as practitioners, advice, and recommendations from policymakers and healthcare experts, and research outcomes. In our analysis, we develop and apply an innovative disparities and resilience (D&R) framework to identify external and internal perspectives and understand better disparities and resilience as they pertain to this population.

RESULTS

Results of this initial study support previous research that LGBTQ+ elders experience aggravated health and related social-economic disparities in comparison to the general population of older people. We also find that LGBTQ+ elders leverage individual toughness and community closeness, and quickly adapt mentally and technologically, despite inadequate social infrastructure for sharing health information and elders' often low social economic status. The methods used therefore are able to surface distinctive resilience in the face of distinctive disparities.

CONCLUSIONS

Our study provides evidence that methodological innovation in gathering and analyzing digital data relating to overlooked, disparately affected, and socially and economically marginalized intersectional communities such as LGBTQ+ elders can result in increased external and self-knowledge of these populations. Specifically, it demonstrates the potential of computational discourse analysis to surface hidden and emerging issues and trends relating to a multi-faceted population that has important concerns about public exposure in highly timely and automated ways. It also points to the potential benefits of triangulating data gathered through this approach with data gathered through more traditional mechanisms such as surveys and interviews.

TRIAL REGISTRATION

Not Applicable.

"I don't feel like I'm a person": Nursing knowledge of transgender care through the lens of transgender people

AIMS

One aim of this study was to discover and understand the perceptions of healthcare delivery for transgender people who have had interactions with nurses while receiving care. An additional purpose of this study was to identify if these perceptions of nursing knowledge have an influence on transgender individuals seeking future healthcare.

DESIGN

Qualitative, interpretive description.

METHODS

Recruitment of participants and interviews took place between September and November 2020. Confidentiality and protection of human participants was prioritized, and data analysis concluded in early 2021.

RESULTS

Ten participant interviews were completed until data saturation were determined. One overarching theme and five supporting themes were constructed from data. Based on participant experiences, these themes reflect transgender peoples' perceptions of nursing knowledge of transgender care and how these perceptions impact seeking future healthcare.

CONCLUSION

Experiences that shaped transgender peoples' perceptions of nursing knowledge of transgender care varied depending on the locations of these services and the experience and understanding of registered nurses. These findings highlight the perceptions that transgender people have of registered nurses' knowledge of transgender care and the influence that those perceptions have on them seeking future healthcare.

Advancing Gerontological Health Research With Sexual and Gender Minorities Across the Globe

The current article presents results of a scoping review of international research on the health and health care needs of sexual and gender minority (SGM) older adults. Electronic databases and related resources were used to identify empirical and review studies published during the past 10 years. We reviewed 33 peer-reviewed articles from 19 countries. Findings were organized using the SGM Health Disparities Research Framework, which highlights factors at individual, interpersonal, community, and societal levels that impact health. Overall, historic and current environmental factors, including stigma, discrimination, and social exclusion, played an important role in SGM older adults' health, health care access, and use of related aging and social services. There is a critical need for training and future research, and health professionals are needed to advance gerontological health and health care research and improve the health and care of SGM older adults globally. [Journal of Gerontological Nursing, 48(4), 13-20.].

Role-play simulation to teach nursing students how to provide culturally sensitive care to transgender patients

OBJECTIVE

Increase student knowledge and comfort with caring for a transgender individual and confronting colleagues when exhibiting poor cultural intelligence.

BACKGROUND

Transgender patients often experience health care inequities, including heteronormative microaggressions in communication and policies. Simulation has been a successful means of providing students with the education, tools, and experience necessary to combat systemic injustice in health care. Simulation is an interactive pedagogy that allows nursing students to practice assessment, patient care, and difficult conversations in a controlled, risk-free environment.

DESIGN/ METHODS

Prelicensure nursing students role-played a simulation created as an interactive learning strategy to promote culturally sensitive assessment of a transgender patient and their caregiver, including assessing for pronouns and providing patient-centered care. The simulation included preforming a difficult conversation between nurses to cultivate an environment of being an upstander. The simulation demonstrated holistic methods of assessing and supporting unique patient needs for the patient who is transgender.

RESULTS

Nursing students reported they felt that their comfort with advocacy and ability to communicate with transgender patients, as well as with their families, and health care team members was enhanced after completing the simulation.

CONCLUSION

Simulation has the ability to reduce discomfort and discrimination in health care for transgender patients by equipping students with culturally sensitive and inclusive communication tools and providing them with risk-free environment where they can learn to provide care for this vulnerable population in preparation for successful future encounters.

Pierre M. A Framework for Enhancing Access to Equitable Home Care for 2SLGBTQ+ Communities

Canadian, US, and UK public health and clinical research has identified barriers to health service access for Two-Spirit, lesbian, gay, bisexual, transgender, queer, non-binary, and intersex (2SLGBTQ+) communities. While offering important insight into the health service experiences of 2SLGBTQ+ communities, this body of research only recently, and still only minimally, reports on home care access experiences. Drawing on key findings from the 2SLGBTQ+ Home Care Access Project, a mixed-methods, Ontario-wide study, this paper animates an Access and Equity Framework, using participant stories and perspectives to underscore the relevance and effectiveness of the Framework as a tool to support systematic organizational assessment, evaluation, and implementation of access and equity strategies. Home care organizations can use this tool to assess their programs and services along a continuum of intentionally inviting, unintentionally inviting, unintentionally disinviting, and intentionally disinviting care for 2SLGBTQ+ people. To support this process, the framework includes six indicators of access to care: community engagement, leadership, environment, policies and processes, education and training, and programs and services.

Designing a Program to Serve Older Adult LGBTQ+ Populations in Home Healthcare

When compared with their heterosexual cisgender (nontransgender) counterparts, LGBTQ+ older adults are more likely to delay or not seek medical care, often due to fear of real or perceived discrimination from healthcare providers. HCR Home care is a home healthcare agency in Upstate New York that has been delivering high-quality in-home healthcare services for over 40 years. We recognized that we had a unique opportunity to address the vulnerabilities of older adults in the LGBTQ+ community and to better meet their health needs as they age in place. We developed a five-step process to implement a program to better serve the home healthcare needs of the LGBTQ+ population in our community. The goal of this initiative is to provide ongoing community education on home healthcare, awareness of the social and health issues surrounding LGBTQ+ older adults, and ultimately to improve care and decrease health disparities. This article describes the five-step process, the challenges, successes, and implications for the future. Ensuring there are healthcare solutions available for vulnerable and marginalized individuals is key to changing the way home healthcare is structured and improving quality of life and health outcomes for all.

Abrindo os armários do acesso e da qualidade: uma revisão integrativa sobre assistência à saúde das populações LGBTT

Resumo A pesquisa buscou estudar as situações que condicionam o acesso e a qualidade da assistência à saúde de lésbicas, gays, bissexuais, travestis e transexuais (LGBTT) nos serviços de saúde, a partir de uma revisão integrativa da literatura nacional e internacional, cuja amostra de 41 artigos foi selecionada nas bases PubMed, Lilacs e SciELO, no período entre 2007 e 2018. O acesso e a assistência à saúde das populações LGBTT foram discutidos em três dimensões: relacional, que diz respeito às relações intersubjetivas entre usuários e profissionais; organizacional, que se refere aos modos de organizar os serviços e os processos de trabalho; e contextual, que engloba como situações de vulnerabilidades imbricadas com os determinantes sociais afetam as condições de satisfação das necessidades de saúde. Os dados mostraram que as populações LGBTT são alvo de preconceitos, violências e discriminações, que, somados a diferentes marcadores sociais, engendram um contexto de vulnerabilidades no acesso e na assistência à saúde. É necessário transformar as práticas e as relações sociais que se dão no interior das instituições de saúde, do contrário, corre-se o risco de afastar cada vez mais parte dessas populações dos serviços de saúde.

Are all LGBTQI+ patients white and male? Good practices and curriculum gaps in sexual and gender minority health issues in a Dutch medical curriculum

Objectives: People marginalized based on their sexual and gender identity face specific health risks and experience barriers to culturally competent care. Insight into how Dutch medical schools address LGBTQI+ health-related learning objectives is scarce. We therefore examined how LGBTQI+ health issues are integrated in the Amsterdam UMC-VUmc medical curriculum by evaluating the year-two course 'Sex, Sexuality and Relationships' for LGBTQI+ content. Methods/Design: We examined written course content (course syllabus, lecture notes, and course literature) of the 2016-2017 course. We used a framework for essential LGBTQI+ content in medical education and an intersectional approach to examine which LGBTQI+ themes and subthemes were addressed. Results: Several essential LGBTQI+ health issues were adequately addressed and integrated into the Amsterdam UMC-VUmc curriculum, but we also identified curriculum gaps. The needs of patients with lesbian, bisexual, or gender non-conforming identities were marginally addressed, and issues related to intersections of minoritized sexual and gender identities with other aspects of diversity such as ethnicity, age and class remained unexplored. The course discussed gender and sexuality as fixed and mainly binary constructs, and only addressed biomedical explanatory models of sex, gender and sexuality. Discussion and conclusion: The absence of complex patient identities in relation to sex, gender and sexuality does not adequately prepare students to provide LGBTQI+ responsive care. If not designed and taught competently, LGBTQI+-related curriculum content may reproduce bias and stereotypes, and contribute to a medical climate where both LGBTQI+ patients, students, and doctors conceal their identities. Further implementation of LGBTQI+ health issues is required in (continuing) medical education to secure culturally competent clinical environments. Educational research is needed to understand how medical education contributes to marginalization of LGBTQI+ identities and thus, to health disparities.

The Impact of Positive Space Training on Students' Communication With LGBTTQ+ Communities

The lesbian, gay, bisexual, transgender, two-spirit, and queer (LGBTTQ+) communities have experienced discrimination from nurses and other health care professionals, resulting in health inequity. The purpose of this study was to examine the impact of positive space training on students' knowledge and comfort level with LGBTTQ+ communities. A quasi-experimental study with surveys and focus groups was conducted with 160 students. All participants perceived an increase in knowledge and comfort in communicating with LGBTTQ+ people after training. Positive space training can be part of the bank of learning strategies we offer students to increase their knowledge and comfort when interacting with LGBTTQ+ communities.

Later Life Care Planning and Concerns of Transgender Older Adults in Canada

While the particular health-care concerns of transgender people have been documented and transgender aging is an emerging area of scholarship, little is known about planning for later and end-of-life care among transgender older adults. As part of a larger project, focus groups and interviews were conducted with 24 transgender older adults (average age 70 years) living in five cities in Canada exploring their concerns and explicit plans for later life care. Three primary themes emerged: (a) “dealing with the day-to-day” reflecting economic precarity and transitioning in later life, (b) fractures and support within family and community, and (c) “there’s a huge gap between principle and practice” reflecting mixed experiences and perceptions of health-care services. These themes suggest that effective promotion of care planning among older transgender persons requires an appreciation of the daily exigencies of their lives and the extent and nature of social support available to them.

Fostering positive spaces in public health using a cultural humility approach

Culturally competent frameworks used within health care systems are contributing to the discrimination and marginalization of sexually and/or gender diverse persons. In this discursive paper, we argue that cultural humility ought to be implemented as the best practice approach for fostering sexually and gender diverse positive spaces in public health settings. A paradigm shift away from cultural competence frameworks toward cultural humility is necessary. This shift can be achieved by enhancing educational opportunities for public health nursing students and professionals and by recruiting organizational leaders to be champions for systemic change. In order to achieve this, we must establish effective educational programs that espouse cultural humility practices and develop valid measurement tools for assessing the provision of culturally humble care. This would equip educators, students, practitioners, and organizational leaders with the necessary tools to guide and assess their performance. Integrating a culturally humble approach will ultimately enhance self-reported cultural safety in public health spaces and reduce health inequities experienced by sexually and/or gender diverse clients and staff members.

Biological, Psychological, Social, and Legal Aspects of Trans Parenthood Based on a Real Case-A Literature Review

Trans men are people who, based on their genitals, were assigned the status of female at birth. However, their identity and their way of living gender do not correspond to the socially established norms. In this paper, we discuss the different perspectives in relation to transgender people and their desire for parenthood. This review, and the basis of this paper, is inspired by the case of a trans man who desired gestation with his own genetic material. He began the cycle of assisted reproduction when he was a legally recognized woman, but that attempt ended with a miscarriage. From that assisted reproduction cycle, four embryos remained frozen. After the failed experience of gestation, the person completed his transition. Now legally a man, he attempted to gestate using his reproductive organs. This literature review aimed to identify relevant studies describing the relationship between transgender person and biological parenthood. This study comprehensively addresses important aspects one should know when considering a transgender pregnancy. These factors include biological, psychological, social, and legal issues. After reviewing the state-of-the-art information on trans parenthood, the main conclusion is that ‘the desire to have a child is not a male or female desire but a human desire’.

The inclusion of LGBT+ health issues within undergraduate healthcare education and professional training programmes: A systematic review

BACKGROUND

An inclusive health curriculum within undergraduate and continuing professional development programmes (CPD) should include issues related to people whom identify as LGBT+.

OBJECTIVES

The aim of this systematic review was to examine the education and training requirements of undergraduate students and health professionals regarding the inclusion of LGBT+ health issues.

DESIGN

A systematic review of the available published empirical studies.

DATA SOURCES

A systematic literature search was undertaken of the following databases: CINAHL, PubMed, PsycINFO, Embase and Sociological Abstracts. All papers reviewed were from the years 2007 to 2017 and written in English.

REVIEW METHODS

Three research questions informing the literature review were: (i) What are the education and training requirements of undergraduate students and health professionals regarding the health needs of LGBT+ people? (ii) What are the approaches utilized in the education and training of undergraduate students and health professionals regarding the health needs of LGBT+ people? (iii) What are the best practice examples of the education and training of undergraduate students and health professionals? Following the application of definitive criteria, 22 papers were included in the review. Quality appraisal and data extraction was undertaken by the two authors.

RESULTS

The 22 papers were reviewed in detail in the final data analysis and synthesis where four main themes were identified: (1) Cultural competence and inclusivity. (2) Existing knowledge of LGBT+ health-related issues. (3) Curriculum developments and outcomes. (4) Evidence of best practice in education delivery.

CONCLUSION

The review highlights the importance of the inclusion of LGBT+ health-related issues within the health curriculum and continuing professional development programmes and the implications for education and training, clinical practice and research.

Barriers in the social and healthcare assistance for transgender persons: A systematic review of qualitative studies

AIM

To explore the barriers to requesting social and healthcare assistance perceived by transgender persons and professionals involved in the assistance.

METHOD

A meta-study, qualitative systematic review, of studies published in English or Spanish, exploring the barriers, perceived by transgender persons and social and healthcare professionals, that transgender persons have when they seek social and healthcare assistance was carried out in the following databases Medline (PubMed), Scopus, Web of Science, Spanish National Research Council, CUIDEN, ProQuest, PsycINFO and CINAHL.

RESULTS

Two thousand two hundred and sixty-one articles were found in the databases searched. Seven articles met all inclusion criteria and were included in this review. The professionals highlight the uncertainty when treating transgender persons and their lack of training. Transgender persons highlight the lack of information and the sense of helplessness it creates. Perceptions of transphobia, the fragmentation of services, administrative barriers, the lack of cultural sensitivity and professional training are also considered barriers to assistance.

DISCUSSION

The findings of this study provide key information for the design of plans and programmes to improve the quality of social and health care for transgender persons.

Older lesbians receiving home care: formal and informal dimensions of caregiving

Older lesbians face the triple jeopardy of ageism, sexism, and heterosexism, and their experiences are largely invisible. This qualitative, exploratory study examines the formal and informal caregiving experiences of 20 lesbians, 65 and older, who had utilized home care services due to acute illness or chronic disabilities. Half of those not partnered reported some level of isolation from support networks. Nearly all study participants eventually found home care workers with whom they were satisfied and even quite connected. Practice implications are discussed in context of study participants' views of how being lesbian affects their aging process and day-to-day lives.