Using interactive theatre to help fertility providers better understand sexual and gender minority patients

Am I Broken?: A mixed-method analysis of an ethnotheatrical performance about women's experiences with infertility and friendship

BACKGROUND

This study evaluated an ethnotheatrical performance about infertility to bring awareness to the health condition and its impact on friendships.

METHODS

After each performance (N = 2), attendees participated in a talkback session to express thoughts and ask questions about the production; then, they completed a survey describing their overall experience. Analyses included descriptive statistics for Likert questions and a thematic analysis for open-ended responses.

RESULTS

Eighty-six percent of attendees found the performance informative about the challenges infertility imposes on everyday life, and more than 60% gained new information and advice on how to talk about infertility. The thematic analysis revealed three themes: learn about the complexities of infertility experiences, develop empathy towards individuals with infertility, and respond appropriately to individuals coping with infertility.

CONCLUSION

The performance offered a safe environment for attendees to learn, understand, and process infertility's complex nature. Creating awareness influenced participants' perceptions and communicative behaviors.

Reimagining sexual and reproductive healthcare for LGBTQ communities

Qualitative interviews were conducted with nine individuals identifying as LGBTQ to identify recommendations for improving sexual and reproductive healthcare at a local clinic on the California Central Coast. Interviewees were recruited at local Pride events. Grounded theory methodology revealed several themes related to participants' desires for a LGBTQ-affirmative sexual and reproductive healthcare setting. Themes identified included: Beyond Enacted Inclusivity (avoiding a performative demonstration of LGBTQ-affirming care); Anti-Institutional Care (a political and visual challenge to what the healthcare setting should look like), a One-Stop-Shop (encompassing several types of care under one roof); Constrained Visibility (where LGBTQ identities are reflected but not exposed); and Community and Social Wellness (to be in community with other LGBTQ-serving organisations and one another in mutual support and celebration). Research implications and clinical recommendations are described at the local and system levels.

Interactive community-based theatre to address social barriers to accessing reproductive health services in patriarchal societies: the case of Jordan

Interactive community-based theatre is used to engage with audience members and allow for free exchange of ideas relevant to context. It aims to bring about a new understanding of an issue while challenging people's attitudes and perceptions. Its application within the field of sexual and reproductive health has been limited, particularly in low and middle-income contexts. This paper presents the rationale for a research-arts partnership in Jordan and describes the process and some lessons learned from the development and country-wide performances of a research-informed interactive play. The play, Mish 'Ayb (Not a Shame) was designed to address social barriers to accessing sexual and reproductive services in a patriarchal society. The sensitive portrayal by Jordanian actors of real-life scenarios pertaining to specific health issues encouraged identification of the audience with the actors, thereby building trust. This process helped to uncover cultural norms that facilitate and impede people's access to health services and information. Qualitative research designs that incorporate interactive theatre present a strong potential avenue to explore sensitive topics related to sexuality, particularly in patriarchal contexts.

Mapping Accessibility to Fertility Preservation for Trans Masculine Individuals in the Netherlands

Purpose: Since 2014 in the Netherlands, sterilization is no longer required for legal gender affirmation. Access to fertility preservation (FP) options is indispensable to grant equal reproductive rights to this population. This study aims to map existing literature on barriers and enabling factors for trans masculine individuals to access FP in the Netherlands after 2014. Methods: A scoping review method was conducted, including a database and a hand search complemented with informal consultations. Literature between 2014 and 2021 was searched. Results: A total of 38 peer-reviewed articles and 22 complementary gray literature sources were retrieved. Thematic analysis identified seven common themes: biological, psychological, training, language, law and legislation, economic, and sociocultural. The themes were clustered as patient-, health care provider (HCP)- and environment-related. Conclusion: The Netherlands offers progressive legislation and accommodating insurance agreements that favor FP for trans masculine individuals. However, the current readiness of HCPs to provide adapted and tailored care is arguable, and the capacity to access appropriate health services for trans masculine individuals is largely nonexistent outside of highly specialized health institutions. The implementation of both formal and informal education training programs for HCPs on transgender and gender diverse health needs-as well as inclusive language use-could benefit this community at large.

Gesundheitliche Themen von LSBTIQ+Personen in der ärztlichen Ausbildung in Deutschland

AIMS

Lesbian, gay, bisexual, trans, intersex and queer (LGBTIQ +) persons continue to experience discrimination and disadvantage in many areas of life, including healthcare. Studies indicate that LGBTIQ+persons show high rates of chronic physical and mental illness on the one hand, and report negative experiences with health care providers on the other hand. The aim of this work is to point towards barriers and the provision of inadequate health care for LGBTIQ+persons, and to draw attention to relevant gaps in medical education in Germany, needing to be followed by specific actions.

METHODS

For these purposes, both scientific evidence for the disadvantage of LGBTIQ+persons within the health care system and important innovative interventions in the education of medical personnel are presented and discussed.

RESULTS

A variety of different - in terms of scope, format, and content - training programs have already been tested and established, mainly in English-speaking regions of the world. In contrast, medical training in Germany lacks such programs.

CONCLUSIONS

Raising awareness and expanding the training of medical students to include LGBTIQ+health topics is of great importance in Germany.

Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review

OBJECTIVE

The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being.

DESIGN

Rapid scoping review.

SEARCH STRATEGY

A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion.

RESULTS

Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process.

CONCLUSION

We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities.

REGISTRATION

The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).

Even Mists Have Silver Linings: Promoting LGBTQ+ Acceptance and Solidarity through Community-Based Theatre in India

OBJECTIVES

This project aimed to assess the effectiveness of a community-based theatre intervention to improve attitudes towards and increase knowledge about LGBTQ+ communities among audiences in Mumbai, India.

STUDY DESIGN

This study was a program evaluation using pre- and post-show surveys that incorporated an adapted version of The Riddle Scale: Attitudes Towards Difference and questions assessing self-reported knowledge about LGBTQ+-related issues to assess changes in attitudes and knowledge after viewing the theatre intervention.

METHODS

An original 90-min devised play was created by a company of Indian, American, and Canadian theatre artists using Participatory Action Research methods and was designed to bring audiences to a deeper understanding of LGBTQ+ identity. The show was performed four times in Mumbai, India, and pre-/post-show surveys were collected at each performance. Audience survey responses were analysed using parametric and non-parametric descriptive statistics as appropriate, and Likert scale questions were compared using Wilcoxon Signed Rank for non-parametric data.

RESULTS

A total 184 surveys were completed across four performances between March 7 and 14, 2020. Significant increases in audiences' self-reported knowledge of LGBTQ+ identity, impacts of discrimination, and struggles faced by LGBTQ+ communities were reported after viewing the show. Furthermore, attitudes towards LGBTQ+ rights, understanding of the challenges of being LGBTQ+ in India, and recognition of the contributions LGBTQ+ individuals make to society improved significantly among our audiences after test. The play further fostered increased acceptance of prosocial behaviours towards LGBTQ+ individuals with higher percentages of audiences recognizing the importance of standing up to homophobia and anti-gay attitudes. While these observations were seen across audiences, they were particularly pronounced among cisgender heterosexual men and audiences ages 18-24.

CONCLUSION

Community-based theatre intervention is highly acceptable and effective as a medium for informing positive attitudes, improving knowledge, and promoting acceptance of and solidarity towards LGBTQ+ communities among young adult heterosexual audiences.

The educational benefits of drama in nursing education: A critical literature review

BACKGROUND

With the increasing use of technology in nursing, the importance of interpersonal skills can often be forgotten. Patient safety can also be compromised if these skills are not emphasised in nursing education.

OBJECTIVES

This review explores how drama in undergraduate and postgraduate nursing education can enhance the development of interpersonal skills such as empathy, emotional intelligence and communication.

DESIGN

A critical review of qualitative literature.

DATA SOURCES

Seven databases (CINAHL, MEDLINE, Scopus, Eric, Psycinfo, and databases dedicated to the Arts, Modern Language Association (MLA) and JSTOR were searched.

REVIEW METHODS

Studies were screened against inclusion and exclusion criteria. Data from studies selected for the review were extracted using a summary table and a thematic analysis was conducted to identify major themes to answer the research question.

RESULTS

1275 studies were identified. Following a rigorous screening process, 29 studies met the inclusion criteria and were critically appraised using the CASP tool. Of the 29 studies, 17 were excluded due to their methodological quality. A final 12 studies were included in this review. Four themes demonstrated the value of drama in nursing education. These were an understanding of the patient experience, the development of professional identity, the enhancement of communication skills and increased self-reflection and critical thinking.

CONCLUSIONS

Interpersonal skills are at the core of nursing and educational interventions that use drama can enhance the development of these skills.

Fertility Counseling for Transgender Adolescents: A Review

International guidelines in transgender health recommend fertility counseling before the commencement of puberty suppression, estrogen, or testosterone, given the potential for these treatments to impair fertility. However, these recommendations provide little actual guidance to clinicians. Consequently, differences in knowledge and attitudes may lead to clinicians adopting different approaches and goals in the fertility counseling they provide. This review draws attention to the disparity between the rates of desire for genetic parenthood among transgender individuals and the actual rates of fertility preservation (FP) and examines different factors in fertility counseling that affect clinical practice and contribute to this disparity. These factors include how a lack of strong evidence-for the effects of hormone therapy on future fertility and success rates of some FP options-impacts upon counseling, transgender peoples' experiences of fertility counseling and preservation, consideration of a young person's developmental stage and the roles of parents and clinicians in the decision-making process, considerations shaping transgender adolescents' decisions to preserve fertility, and access barriers to FP. In doing so, this review highlights the complexities and issues that clinicians must consider when providing fertility counseling to transgender adolescents and-in part-helps to address the lack of detailed clinical guidelines in this area.

Attitudes and experiences of health care professionals when caring for transgender men undergoing fertility preservation by egg freezing: a qualitative study

Background:

As gender-affirming treatment may have a negative impact on fertility, reproductive health counseling to patients seeking medical or surgical gender-affirming treatment should be provided, including the option to undergo fertility preservation (FP). Experiences of transgender men undergoing FP treatments aimed at oocyte freezing have reported a negative impact of the treatments on gender dysphoria. No previous studies have investigated the experiences of health care professionals’ (HCP) when caring for transgender men undergoing such treatments.

Aim:

The aim of this study was to investigate HCP’s attitudes and experiences when meeting transgender men undergoing FP through oocyte freezing.

Methods:

Individual interviews were conducted in 2016 with 13 HCPs working at a Reproductive Medicine clinic in Sweden. Data were analyzed by thematic content analysis.

Results:

The main theme found, How to maintain professionalism, showed that HCPs experienced important challenges to their professionalism when their preconceived opinions and values about gender and transgender were confronted.

Discussion:

Our findings demonstrate the need of continuous efforts on assessing learning needs as well as addressing preconceived opinions and values of HCP. By gaining knowledge and self-confidence in the care of transgender individuals undergoing FP, a professional care for transgender people can be achieved and a safe environment can be established for the patients. This in turn may alleviate some of the distress that may arise when transgender men undergo FP.

Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review

BACKGROUND

Lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals experience higher rates of health disparities. These disparities may be driven, in part, by biases of medical providers encountered in health care settings. Little is known about how medical, nursing, or dental students are trained to identify and reduce the effects of their own biases toward LGBTQ individuals. Therefore, a systematic review was conducted to determine the effectiveness of programs to reduce health care student or provider bias towards these LGBTQ patients.

METHODS

The authors performed searches of online databases (MEDLINE/PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar) for original articles, published in English, between March 2005 and February 2017, describing intervention studies focused on reducing health care student or provider bias towards LGBTQ individuals. Data extracted included sample characteristics (i.e., medical, nursing, or dental students or providers), study design (i.e., pre-post intervention tests, qualitative), program format, program target (i.e., knowledge, comfort level, attitudes, implicit bias), and relevant outcomes. Study quality was assessed using a five-point scale.

RESULTS

The search identified 639 abstracts addressing bias among medical, nursing, and dental students or providers; from these abstracts, 60 articles were identified as medical education programs to reduce bias; of these articles, 13 described programs to reduce bias towards LGBTQ patients. Bias-focused educational interventions were effective at increasing knowledge of LGBTQ health care issues. Experiential learning interventions were effective at increasing comfort levels working with LGBTQ patients. Intergroup contact was effective at promoting more tolerant attitudes toward LGBTQ patients. Despite promising support for bias education in increasing knowledge and comfort levels among medical, nursing, and dental students or providers towards LGBTQ persons, this systematic review did not identify any interventions that assessed changes in implicit bias among students or providers.

CONCLUSIONS

Strategies for assessing and mitigating implicit bias towards LGBTQ patients are discussed and recommendations for medical, nursing, and dental school curricula are presented.

TEATRO DO OPRIMIDO E PROMOÇÃO DA SAÚDE: TECENDO DIÁLOGOS

Resumo O estudo aqui apresentado buscou discutir as contribuições do teatro do oprimido na promoção da saúde, visando a colaborar para a consolidação desse diálogo de maneira que as repercussões no desenvolvimento das experiências práticas sejam potencializadas. Dentre as duas principais vertentes da promoção da saúde, registra-se a incompatibilidade entre os alicerces éticos, estéticos e políticos que fundamentam o teatro do oprimido e os pressupostos teóricos da corrente behaviorista, uma vez que esse teatro se afasta de qualquer tentativa de domesticação dos corpos e de normatização de comportamentos, hábitos e estilos para que sejam atingidos padrões (classificados por alguns como) saudáveis. Já com relação à perspectiva da nova promoção da saúde, de politização e busca de aproximação entre saberes científicos e técnicos com os saberes populares, observaram-se maiores consonâncias entre ela e o teatro do oprimido, a partir do momento em que ambos logram o fortalecimento de práticas cidadãs questionadoras do status quo e de mudanças sociais em prol de uma transformação libertária e crítica.