1
|
Jerala N, Petek D. Enhancing LGBT + primary healthcare in Slovenia: A national qualitative study of experiences and expectations of LGBT + people and family doctors. Eur J Gen Pract 2024; 30:2373121. [PMID: 38979662 PMCID: PMC11271072 DOI: 10.1080/13814788.2024.2373121] [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: 11/25/2023] [Revised: 03/30/2024] [Accepted: 06/11/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Despite growing acceptance of LGBT + individuals, an underlying stigma persists even in healthcare, resulting in substandard care and worse healthcare outcomes for LGBT + individuals. OBJECTIVES To examine and compare the experiences and expectations regarding primary healthcare among LGBT + individuals and general practitioners (GPs) in Slovenia. METHODS We conducted an online national qualitative study using open-ended questions. To reach LGBT + population snowball method of recruitment was employed by sharing the questionnaire through LGBT + organisations, while GPs were invited by email of Association of family doctors in Slovenia. Anonymous data was collected from October to December 2021 and the questionnaires of 25 GPs and 90 LGBT + individuals of various ages, backgrounds, gender identities and sexual orientations were reviewed using thematic analysis. RESULTS Both LGBT + participants and GPs expressed a desire for equal treatment. However, while all GPs claimed to treat all patients equally, LGBT + participants reported more varied experiences. Specific knowledge, especially on LGBT + terminology and healthcare, was perceived as lacking among GPs, leading LGBT + individuals to seek advice from specialists or community counselling. Systemic barriers, including societal stigmatisation and limited formal education on LGBT + issues, were identified, highlighting the need for designated safe spaces and improved GP training. Safety emerged as a central theme, crucial for fostering trust and disclosure between patients and healthcare providers. CONCLUSION The study underscores the significance of a sense of safety in the patient-doctor relationship and highlights the need for improved training and attitudes to provide inclusive and affirming healthcare for LGBT + individuals.
Collapse
Affiliation(s)
- Nina Jerala
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Davorina Petek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
2
|
Tse S, Chee K, Coleman TA, Coulombe S, Travers R. Exploring LGBT2Q+ Intracategorical Factors in Mental Health Service Utilization: Differences in Gender Modalities, Sexual Orientations, and Ethnoracial Groups in Canada. Community Ment Health J 2024; 60:1434-1447. [PMID: 38850503 DOI: 10.1007/s10597-024-01299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/19/2024] [Indexed: 06/10/2024]
Abstract
LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.
Collapse
Affiliation(s)
- Samson Tse
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada.
| | - Kenny Chee
- Faculty of Social Works, University of Toronto, Toronto, ON, Canada
| | - Todd A Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Simon Coulombe
- Department of Industrial Relations, Université Laval, Québec, QC, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| |
Collapse
|
3
|
McLean M, Bogle D, Diggins C, MacInnis M, MacDonald A, Wilby KJ. A Scoping Review of Interprofessional Education Training Aimed to Improve 2SLGBTQ+ Health. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100683. [PMID: 38471638 DOI: 10.1016/j.ajpe.2024.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/18/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES This scoping review aims to identify and summarize the available literature on 2-spirited, lesbian, gay, bisexual, transgender, queer, plus (2SLGBTQ+) interprofessional health education and to identify optimal methods of interprofessional training to improve health care professional competency for this patient population. METHODS A search of PubMed and Embase was conducted and supplemented with a manual search of reference lists from identified articles. Articles were included if they reported an interprofessional education event on the topic of 2SLGBTQ+ health to at least 2 or more groups of health care professionals or students. Article screening was completed independently by 2 reviewers. Data from the included articles were extracted and mapped according to the type of participant (health care students or working health care professionals), type of event (workshop, case-based, course/curriculum, or forum), and type of assessment. RESULTS One hundred articles were screened, of which 15 articles met the inclusion criteria. Twelve articles focused on interprofessional health education for entry-to-practice students, with the remaining 3 articles involving practicing health care professionals. When mapped by type of event, 1-time case-based and workshop style events were the most used to deliver training. All 15 studies used an immediate presurvey and postsurvey design to evaluate the knowledge and competence of the participants after training. CONCLUSIONS Interprofessional education for improving 2SLGBTQ+ health is largely delivered within entry-to-practice degree programs via 1-time events with knowledge- and confidence-based assessments. Further research is needed to determine the impact of this training in practice, as well as the applicability for the training of practicing health care professionals.
Collapse
Affiliation(s)
- Madison McLean
- IWK Health, Halifax, Nova Scotia, Canada; Dalhousie University, Faculty of Health, College of Pharmacy, Halifax, Nova Scotia, Canada
| | | | | | | | | | - Kyle John Wilby
- Dalhousie University, Faculty of Health, College of Pharmacy, Halifax, Nova Scotia, Canada.
| |
Collapse
|
4
|
Schafer T, Schnarrs PW, Baldwin A. Two Gender Medicine: Provider-Side Barriers to Caring for Transgender and Gender Diverse Patients. JOURNAL OF HOMOSEXUALITY 2024:1-23. [PMID: 38319650 DOI: 10.1080/00918369.2024.2314030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Experienced and anticipated discrimination during health care visits result in lower health care utilization rates, which contribute to persistent health disparities between transgender and gender diverse (TGD) individuals and the general population. Most strategies for improving health care delivery to TGD patients place the responsibility on providers, overlooking the role of medical systems and institutions in creating the environments where negative health care experiences occur. Relying on the inhabited institutionalism framework, this study explores system- and institutional-level barriers to the provision of quality care to TGD patients identified by health care providers and administrators, including relevant contextual details of, and interactions between, these barriers. Based on interview data from health care providers and administrators from a variety of practices across Texas, we identified two overarching themes and six subthemes. We demonstrate how our interviewees' responses reveal an institutional logic of "two-gender medicine," which creates barriers to health care provision in both formal medical education and training and throughout the managed care model of practice. We also illustrate how health care workers find ways to resist this logic in the course of their practice. Addressing these barriers to delivering competent and compassionate care to TGD patients that providers encounter could make long overdue strides toward addressing health disparities.
Collapse
Affiliation(s)
- Tyler Schafer
- Department of Sociology, California State University Stanislaus, Turlock, California, USA
| | - Phillip W Schnarrs
- Department of Population Health, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Aleta Baldwin
- Department of Public Health, California State University Sacramento, Sacramento, California, USA
| |
Collapse
|
5
|
Langenbach BP, Thieme A, van der Veen R, Reinehr S, Neuendorff NR. Attitudes towards sex workers: a nationwide cross-sectional survey among German healthcare providers. Front Public Health 2023; 11:1228316. [PMID: 37744482 PMCID: PMC10513093 DOI: 10.3389/fpubh.2023.1228316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Worldwide, sex workers face stigmatization and discrimination, also within healthcare. Only few studies on healthcare providers' attitudes towards care of sex workers have been performed. This study assessed attitudes and knowledge of healthcare providers in Germany towards sex workers and their specific health risks. Methods German healthcare professionals and medical students were invited to participate in a nationwide cross-sectional study in 2022. The online survey used a German translation of the "Attitudes towards Prostitutes and Prostitution Scale" by Levin and Peled for assessment of attitudes towards sex work and workers, together with prevalence estimates of common mental and physical disorders. Results A total of 469 questionnaires were included into analysis. Older participants tended to regard sex work as less of a choice (p < 0.004) and sex workers as more victimized (p < 0.001). The frequency of professional contact to sex workers neither affected the perception of sex workers' status as victims vs. independent individuals, nor the perceived moral status. Moreover, healthcare professionals overestimated the prevalence of various disorders which was influenced by participants' attitudes towards sex workers. Discussion A comparison to a recent Allensbach survey demonstrated similar attitudes of healthcare providers and the general population towards sex workers. Our results suggest that German healthcare professionals are not free of prejudices against sex workers, as has been shown for other marginalized groups in society. Instead, they seem to be influenced by personal opinion rather than by objective facts which they should have acquired during their professional education. Future interventions (e.g., better training regarding marginal societal groups) are necessary to encounter these issues in order to improve healthcare for sex workers.
Collapse
Affiliation(s)
- Benedikt P. Langenbach
- Department of Psychiatry and Psychotherapy, LVR University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Thieme
- Department of Psychiatry and Psychotherapy, LVR University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Raquel van der Veen
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sabrina Reinehr
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nina R. Neuendorff
- Department of Haematology and Stem Cell Transplantation, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Hufelandstr, Essen, Germany
| |
Collapse
|
6
|
Paudel K, Gupta S, Gautam K, Wickersham JA, Khati A, Azwa I, Ha T, Shrestha R. High Interest in Long-acting Injectable Pre-exposure Prophylaxis (LAI-PrEP) for HIV Prevention Among Men Who Have Sex With Men (MSM): Result From A Nationwide Survey in Malaysia. J Community Health 2023; 48:513-521. [PMID: 36732459 PMCID: PMC10200758 DOI: 10.1007/s10900-023-01195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
The recent approval of long-acting injectable cabotegravir (CAB-LA) as PrEP for HIV prevention could be an attractive alternative for MSM, particularly among those who face barriers to adherence using the oral pill. This study reports on the awareness of long-acting injectable PrEP (LAI-PrEP) and factors associated with interest in LAI-PrEP use among a nationwide sample of MSM in Malaysia. An online cross-sectional survey was conducted between August and September 2021 to explore perspectives on PrEP modalities among Malaysian MSM (N = 870). Convenience sampling was used to recruit participants using ads on two platforms hornet and facebook. While only 9.1% of the study participants were aware of LAI-PrEP, the majority had heard of oral PrEP (80.9%). After giving a description of it, a large majority (86.6%) expressed interest in using it if made accessible. Those who had a prior history of HIV testing (aOR = 1.9; 95% CI = 1.2-3.2) were more likely to use LAI-PrEP. Interestingly, despite the concerns related to potential high cost (aOR = 3.4; 95% CI = 2.1-5.5) and long-term side effects (aOR = 1.9; 95% CI = 1.2-3.1), the majority of the participants were interested in using LAI-PrEP. Those who were afraid of (or disliked) syringes were less interested in using it (aOR = 0.2; 95% CI; 0.1-0.4). In the recent context that LAI-PrEP was shown to be safe and effective at preventing HIV, our results indicate its potential relevance as an additional PrEP option that could accelerate the uptake and scale-up of PrEP. However, it is crucial to conduct future research urgently to improve the understanding of strategies that could enhance the accessibility, acceptability, and affordability of LAI-PrEP for MSM in low- and middle-income countries, including Malaysia.
Collapse
Affiliation(s)
- Kiran Paudel
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, 06269, Storrs, CT, USA
| | - Sana Gupta
- Department of Allied Health Sciences, University of Connecticut, 06269, Storrs, CT, USA
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, 06269, Storrs, CT, USA
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, 06510, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, 06269, Storrs, CT, USA
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Toan Ha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, 15261, Pittsburgh, PA, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, 06269, Storrs, CT, USA.
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, 06510, New Haven, CT, USA.
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- , 358 Mansfield Road, 1101, 06260-1101, Unit, Storrs, CT, USA.
| |
Collapse
|