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Fowler JA, Buckley L, Viskovich S, Muir M, Dean JA. Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey. Psychiatry Res 2024; 335:115873. [PMID: 38555827 DOI: 10.1016/j.psychres.2024.115873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.
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Affiliation(s)
- James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia.
| | - Lisa Buckley
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia
| | - Shelley Viskovich
- The University of Queensland, Faculty of Health and Behavioral Sciences, School of Psychology, St Lucia, Brisbane, QLD 4027, Australia
| | - Miranda Muir
- The University of Queensland, Faculty of Health and Behavioral Sciences, School of Psychology, St Lucia, Brisbane, QLD 4027, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia
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Wesche R, Toman M, Grafsky EL, Gupta S, Tarantino MR. Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women's Sexual Decision-Making. JOURNAL OF SEX RESEARCH 2024:1-15. [PMID: 38687300 DOI: 10.1080/00224499.2024.2320260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18-29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women's sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women's decisions.
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Affiliation(s)
- Rose Wesche
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Madelyn Toman
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Erika L Grafsky
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Shivangi Gupta
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
| | - Mari R Tarantino
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University
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Mejia A, Nyhus K, Burley T, Myhre A, Montes M, Osiecki K, Randolph AC. "Ripping Off the Band-Aid": uncovering future health care Professionals' "Fractured Knowledge" about sexual and reproductive health. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1242885. [PMID: 38590516 PMCID: PMC10999535 DOI: 10.3389/frph.2024.1242885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background Research has shown the role of identity on future health professionals' confidence and competence in addressing the sexual and reproductive health (SRH) needs of their patients. While there has been some work in increasing the sexual health literacy of future providers via various curricular approaches and comprehensive clinical-based training, there are research gaps on how social differences around identity impact future healthcare professionals' knowledge and practices around SRH. Objectives This article presents research findings on the experiences of US undergraduate students attending a campus that provides training in the health sciences and health professions. Our study aims to understand the perspectives of these students as they pertain to their future career choices in healthcare, with a focus on how their past experiences learning about sex, sexuality, and reproduction impact their current and future professional trajectories. Methods We present a qualitative analysis from 40 in-depth interviews with U.S. undergraduates. The interview questions were designed in collaboration with undergraduate researchers interested in sexual health education. These student researchers collected all the interview data and worked with senior researchers to analyze some of these data. Results The themes that emerged from the interviews were around experiences with what students perceived as "fractured" sexual and reproductive health (SRH) knowledge they received as children and adolescents. This knowledge shaped essential aspects of their identity as young adults and future healers. Data indicated unique processes implicated in how past as well as present socialization experiences learning about sex, sexuality, and reproduction positions undergraduates in health professions to see young adulthood as a journey of "catching up" on sexual knowledge but also as an ongoing experience of anticipation and planning influencing their career-building journey. Conclusions The importance of sexual health literacy among healthcare professionals cannot be overstated, as it is vital in providing patient-centered and non-judgmental sexual and reproductive health (SRH) care and services. To date, there is a shortage of studies looking at the impact of sexual health knowledge on healthcare professionals. More research is needed on educational strategies that could be implemented at the intra-personal level to assist college-aged young adults in healthcare career tracks to "catch up" or "fill in the gaps" in their sexual education journey.
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Affiliation(s)
- Angie Mejia
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Kara Nyhus
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, United States
| | - Tessie Burley
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Alexis Myhre
- Augsburg University, Minneapolis, MN, United States
| | - Marcela Montes
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, United States
| | - Kristin Osiecki
- Center for Health Equity, Minnesota Department of Health, Minneapolis, MN, United States
| | - Anita C. Randolph
- Department of Paediatrics, University of Minnesota Twin Cities, Minneapolis, MN, United States
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Noh M, Hughto JMW, Austin SB, Goldman RE, Potter J, Agénor M. Promoting equitable sexual health communication among patients with minoritized racial/ethnic, sexual orientation, and gender identities: Strategies, challenges, and opportunities. Soc Sci Med 2024; 344:116634. [PMID: 38394863 PMCID: PMC10947744 DOI: 10.1016/j.socscimed.2024.116634] [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: 07/06/2023] [Revised: 12/15/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
People assigned female at birth (AFAB) with minoritized racial/ethnic, sexual orientation, and gender identities experience notable barriers to high-quality sexual healthcare. In confronting these barriers, patient-provider communication can be a crucial factor, influencing patients' experiences and access to relevant sexual health information and services by determining the quality of care. However, research that investigates this communication among AFAB patients with minoritized social positions is scarce, indicating a research gap regarding the perspectives and roles of healthcare providers in addressing such barriers to care for minoritized patients. Thus, we conducted a qualitative research study, using individual in-depth interviews, to explore the multi-level factors that influence providers' attitudes, knowledge, and skills regarding sexual health communication with AFAB patients with minoritized racial/ethnic, sexual orientation, and gender identities. Interpreting study findings within frameworks of person-centered care, intersectionality, and structural competency, we identified three cross-cutting themes. We found that providers frequently drew on their prior professional training, personal lived experiences, and population-level health disparities data when engaging in sexual health communication with minoritized AFAB patients. Participants reported minimal explicit training in anti-racist and lesbian, gay, bisexual, transgender, and queer (LGBTQ+)-competent care as a significant barrier to engaging in equitable sexual health communication with minoritized AFAB patients, which was exacerbated by many providers' lack of shared social positions and lived experiences with these patients. Providers also frequently applied population-level data to individual patients when formulating counseling and recommendations, which may undermine person-centered sexual health communication. Our findings suggest that critical anti-racist and LGBTQ+-competent provider training is urgently needed, and that health professional education and institutions must be transformed to better reflect and consider the experiences of patients with minoritized racial/ethnic, sexual orientation, and gender identities.
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Affiliation(s)
- Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, USA.
| | - Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, USA; Department of Epidemiology, Brown University School of Public Health, USA; The Fenway Institute, Fenway Health, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA; Department of Pediatrics, Harvard Medical School, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, USA
| | - Roberta E Goldman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA; Warren Alpert Medical School, Brown University, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, USA; Department of Medicine, Harvard Medical School, USA; Division of General Medicine, Beth Israel Lahey Health, USA
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, USA; Department of Epidemiology, Brown University School of Public Health, USA; The Fenway Institute, Fenway Health, USA
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Keum BT, Maurin-Waters E, Chong ESK. The Mental Health Costs of Online Heterosexism Among LGBTQ+ Individuals: Development and Initial Validation of the Perceived Online Heterosexism Scale. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:525-541. [PMID: 37943472 DOI: 10.1007/s10508-023-02733-0] [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: 04/29/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
Experiences of heterosexism are rampant online, where bias and harassment against LGBTQ+ individuals spread conveniently and widely. Yet, research has been limited in understanding the exposure to online heterosexism among LGBTQ+ individuals partly due to the lack of a quantitative measure to advance this research. Thus, the current study developed and examined the psychometric properties of the Perceived Online Heterosexism Scale (POHS). Items were developed via a literature review, a survey of social media platforms, and an expert review. Exploratory (N = 288) and confirmatory (N = 653) factor analyses yielded a 4-factor structure and produced a 20-item scale with the following subscales: (1) Heterosexist Cyberaggression (4 items), (2) Online Heterosexist Stereotyping (4 items), (3) Online Exposure to Systemic Heterosexism (8 items), and (4) Heterosexist Online Media (four items). Internal consistency estimates ranged from .91 to .96, and the POHS accounted for 65.9% of the variance. Examination of a second-order model suggested that a total scale score can also be used. Initial construct validity was evidenced as POHS scores were associated with an existing heterosexism measure, anxiety and depressive symptoms, internalized heterosexism, and LGBTQ+ community connectedness in line with theory and empirical evidence. Implications for research practice are discussed.
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Affiliation(s)
- Brian TaeHyuk Keum
- Department of Counseling, Developmental & Educational Psychology, Lynch School of Education and Human Development, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA, 02467, USA.
| | - Emily Maurin-Waters
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddie S K Chong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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Griner SB, Johnson KC, Neelamegam M, Webb NJ, Kinard A, Kline N. Direct-to-Consumer Sexually Transmitted Infection Screening Methods: Preferred Communication Sources and Channels Among Young Adult Women. Sex Transm Dis 2023; 50:619-624. [PMID: 37195283 DOI: 10.1097/olq.0000000000001829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Direct-to-consumer (DTC) sexually transmitted infection (STI) screening methods use self-collected samples in a nonclinical setting. Direct-to-consumer methods may reach a population of women who avoid screening because of stigma and privacy concerns, or who lack access to clinical care. Little is known about the salient dissemination approaches to promote these methods. The study's purpose was to identify preferred sources and communication channels for information about DTC methods among young adult women. METHODS Participants were sexually active 18- to 24-year-old college women at one university, recruited via purposive sampling using campus email, list-servs, and campus events to participate in an online survey (n = 92). Interested participants were invited to participate in in-depth interviews (n = 24). Both instruments were guided by the Diffusion of Innovation theory to identify relevant communication channels. RESULTS Survey participants ranked healthcare providers as their preferred source of information, followed by the Internet and college- and university-based resources. Race was significantly associated with the ranking of partners and family members as information sources. Interview themes focused on healthcare providers legitimizing DTC methods, using the Internet and social media to increase awareness, and linking DTC method education to other services provided by the college. CONCLUSIONS This study revealed common information sources that college-aged women may use when researching DTC method information and potential channels and strategies for DTC uptake and dissemination. Using trusted sources including healthcare providers, trusted Web sites, and established college resources as dissemination channels may be beneficial to increase the awareness and use of DTC methods for STI screening.
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Affiliation(s)
| | | | | | | | - Ashlyn Kinard
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX
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Martin P, Alberti C, Gottot S, Bourmaud A, de La Rochebrochard E. Young people's proposals for a web-based intervention for sexual health promotion: a French qualitative study. BMC Public Health 2023; 23:1389. [PMID: 37468863 DOI: 10.1186/s12889-023-16257-8] [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] [Received: 07/28/2022] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Promoting sexual health is key to improving the supportive behaviors and well-being of young people. With the advent of the Internet, web-based features for sexual health promotion may be attractive to a diverse range of young people. This study aims to assess young people's proposals regarding a web-based intervention for sexual health promotion. METHODS Nineteen French young people aged 15-24 years participated to the study. In a semi-structured interview, they presented their views on a web-based intervention for sexual promotion. Data were coded with N'Vivo and subjected to qualitative thematic analysis to explore their proposals. RESULTS The majority of participants (n = 18) thought that a web-based intervention for sexual health promotion would be attractive. Young people interviewed made 31 concrete proposals for sexual health promotion on the Internet. Participatory and interactive dimensions on the internet appeared essential, with the need for stimulating activities and interaction with peers, but also with competent professionals and moderation. Face to the risks of the internet, they expressed the need of a secure and confidential space, to generate trust and participation in intervention. For participants, sexual health should be addressed in all its dimensions, taking into account the relational, sexual, and gender dimensions, and by incrementing on the internet valid, credible and personalized content. CONCLUSIONS In sexual health promotion, young people are indispensable stakeholders who can make concrete proposals and can also participate in content creation and research. More broadly, in health promotion, involving target audiences in decisions represents a promising perspective.
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Affiliation(s)
- Philippe Martin
- Université Paris Cité, ECEVE, Inserm U1123 UFR de Médecine, 10 Avenue de Verdun, 75010, Paris, France.
- AP-HP, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, 1426, Inserm, CIC, France.
- GDID Santé, Paris, France.
- Institut National d'Etudes Démographiques (INED), UR14 - Sexual and Reproductive Health and Rights, Aubervilliers, F-93322, France.
| | - Corinne Alberti
- Université Paris Cité, ECEVE, Inserm U1123 UFR de Médecine, 10 Avenue de Verdun, 75010, Paris, France
- AP-HP, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, 1426, Inserm, CIC, France
| | | | - Aurélie Bourmaud
- Université Paris Cité, ECEVE, Inserm U1123 UFR de Médecine, 10 Avenue de Verdun, 75010, Paris, France
- AP-HP, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, 1426, Inserm, CIC, France
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques (INED), UR14 - Sexual and Reproductive Health and Rights, Aubervilliers, F-93322, France
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, F-94800, France
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Queer enough to swipe right? Dating app experiences of sexual minority women: A cross-disciplinary review. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2022. [DOI: 10.1016/j.chbr.2022.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Waling A, Farrugia A, Fraser S. Embarrassment, Shame, and Reassurance: Emotion and Young People's Access to Online Sexual Health Information. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:45-57. [PMID: 35035599 PMCID: PMC8743101 DOI: 10.1007/s13178-021-00668-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Research suggests that embarrassment and shame are significant barriers to young people's access to sexual health information. In this article, we analyse the relationship between emotion and young people's engagement with online sexual health information. METHODS Drawing on the work of Ahmed on the performativity of emotion and Probyn's theorisation of shame, we analyse interviews conducted in 2020 with 37 young people in Australia on sources of sexual health information. RESULTS Based on themes emerging from the data, our analysis considers the role of embarrassment and shame in shaping young people's access to sexual health information, the sources they seek, and the forms of information provision they prefer. Overall, we find that shame, embarrassment, and judgement shape our participants' access to sexual health information in four key ways: (1) by enacting suitable sources of information; (2) by propelling curiosity in different directions; (3) by constituting 'normal' bodies, sexuality, and sexual health; and (4) by constituting desired forms of communication. CONCLUSIONS As part of these dynamics, our participants use a range of strategies to avoid potential embarrassment or judgement when seeking sexual health information. The article concludes by exploring the implications of these practices and dynamics. POLICY IMPLICATIONS Our analysis suggests the need for research, policy, and public health initiatives that are open to the multiple effects of emotion, including those traditionally thought of as negative, and their role in materialising encounters with sexual health information.
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Affiliation(s)
- Andrea Waling
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Melbourne, VIC 3086 Australia
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Melbourne, VIC 3086 Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Melbourne, VIC 3086 Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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