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Kelly PJ, Myers-Matthews P, Collins AB, Wolfe HL, Miller-Jacobs C, Davis M, Adrian H, Briody V, Fernández Y, Operario D, Hughto JM. A qualitative study of reasons to use substances and substance use treatment experiences among transgender and gender diverse adults in Rhode Island. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100399. [PMID: 38854803 PMCID: PMC11157666 DOI: 10.1016/j.ssmqr.2024.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Patrick J.A. Kelly
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Center for Promotion and Health Equity, Brown University School of Public Health, Box G-121-8, Providence, RI, 02912, USA
| | | | - Alexandra B. Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Cameron Miller-Jacobs
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Madison Davis
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Haley Adrian
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Victoria Briody
- Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Yohansa Fernández
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30329, USA
| | - Jaclyn M.W. Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Center for Promotion and Health Equity, Brown University School of Public Health, Box G-121-8, Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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Manspeaker SA, DeIuliis ED, Delehanty AD, McCann M, Zimmerman DE, O'Neil C, Shaffer J, Crytzer TM, Loughran MC. Impact of a Grand Rounds Interprofessional Workshop: student perceptions of interprofessional socialization and cultural humility. J Interprof Care 2024; 38:460-468. [PMID: 38126233 DOI: 10.1080/13561820.2023.2287671] [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: 05/12/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
While uniprofessional education programs develop strong student identities, they may limit the development of behaviors needed for interprofessional socialization. Interprofessional education (IPE) creates an essential platform for student engagement in the development of interprofessional socialization and cultural humility, thus enabling improvement in collaborative communication. In this quasi-experimental observational study, health professional students attended one of three Grand Rounds Interprofessional Workshops (GRIW) and completed online pre- and post-workshop surveys including sociodemographic background, the Interprofessional Socialization and Valuing Scale (ISVS), and the Cultural Competence Self-Assessment Checklist (CCSAC). A total of 394 students from eight professions participated in the workshop with 287 (73%) of attendees completing both pre- and post-workshop surveys. No significant differences were observed in ISVS and CCSAC scores between students across workshops. Significant pre- to post-workshop differences were found in ISVS [t (284) = 13.5, p < .001, 95%], CCSAC [t (286) = 13.8, p < .001] and the cultural competence components of cultural awareness [t (285) = 12.9, p < .001, 95%], knowledge [t (285) = 9.5, p < .001, 95%], and skills [t (286) = 13.3, p < .001, 95%]. Interprofessional education learning opportunities that integrate socialization with health professional students and cultural humility education can improve educational awareness of cultural values and communication for collaborative professional practice.
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Affiliation(s)
| | | | | | - Michelle McCann
- Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - David E Zimmerman
- Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Christine O'Neil
- Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Joseph Shaffer
- Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | - Mary C Loughran
- Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
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Wolfe HL, Fix GM, Hughto JMW, Hughes LD, Operario D, Hadland SE, Siegel J, Drainoni ML. Understanding how primary care providers report discussing substance use with transgender and gender diverse patients. PATIENT EDUCATION AND COUNSELING 2024; 120:108101. [PMID: 38103396 PMCID: PMC10842839 DOI: 10.1016/j.pec.2023.108101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/28/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To explore how primary care providers report discussing substance use with transgender and gender diverse (TGD) adult patients within the context of discussing gender-affirming interventions. METHODS Between March and April 2022, in-depth, semi-structured qualitative interviews were conducted with 15 primary care providers who care for TGD patients in the Northeastern US. Thematic analysis was used to analyze interview data and identify themes. RESULTS Two primary themes emerged among providers: 1) placing a focus on harm reduction, emphasizing reducing negative consequences of substance use, and 2) using access to gender-affirming interventions as an incentive for patients to change their substance use patterns. CONCLUSIONS Focusing on harm reduction can emphasize reducing potential adverse outcomes while working with TGD patients towards their gender-affirmation goals. Future research should explore varying approaches to how substance use is discussed with TGD patients, as well as the interpretation of gender-affirming clinical guidelines. PRACTICE IMPLICATIONS Findings from this study indicate a need for enhancing provider knowledge around the appropriate application of gender-affirming care guidelines. Investing in training efforts to improve gender-affirming care is critical for encouraging approaches that prioritize harm reduction and do not unnecessarily prevent access to gender-affirming interventions.
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Affiliation(s)
- Hill L Wolfe
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, USA; Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA.
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, USA; Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, USA
| | - Jaclyn M W Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA; Department of Epidemiology, Brown University School of Public Health, Providence, USA; The Fenway Institute, Fenway Health, Boston, USA
| | - Landon D Hughes
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Scott E Hadland
- Division of Adolescent and Young Adult Medicine, Mass General for Children, Boston, USA; Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Jennifer Siegel
- Division of General Internal Medicine, Transgender Health Program, Massachusetts General Hospital, Boston, USA; Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, USA; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA; Evans Center for Implementation and Improvement Sciences, Boston University, Boston, USA
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Hughto JMW, Wolfe HL, Adrian H, Operario D, Hughes LD, Fernández Y, Briody V, Matthews P, Kelly PJA, Collins AB. Understanding the delivery of substance use treatment services to transgender and gender-diverse people: Findings from a mixed-methods study of healthcare professionals. Soc Sci Med 2024; 343:116591. [PMID: 38277762 PMCID: PMC10923070 DOI: 10.1016/j.socscimed.2024.116591] [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: 08/31/2023] [Revised: 12/07/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Transgender and gender diverse (TGD) people who use drugs report barriers to accessing substance use treatment, including provider mistreatment. Little research has explored the multilevel factors that shape the capacity of substance use treatment professionals to provide gender-affirmative care (i.e., care that respects and affirms one's gender) to TGD people. METHODS From October 2021 to March 2022, substance use treatment and harm reduction professionals in Rhode Island were surveyed (N = 101) and qualitatively interviewed (N = 19) about the provision of substance use treatment-related services to TGD people. Quantitative data were analyzed descriptively; differences were examined using Fisher exact tests (p < 0.05). Qualitative interviews were coded and analyzed using thematic analysis. RESULTS Participants reported limited exposure to TGD people and lacked training on TGD health, which resulted in limited cultural and clinical competency and low self-efficacy in their ability to care for TGD people. Participants also highlighted structural factors (e.g., non-inclusive intake forms, limited availability of gender-inclusive ancillary community services) that restricted their ability to provide effective and affirming care to TGD people. Some participants also reported a "gender blind" ethos at their institutions- described by some as ignoring the potential impact of TGD peoples' unique experiences on their substance use and ability to benefit from treatment. While some perceived gender blindness as problematic, others believed this approach enabled substance use treatment professionals to consider all the identities and needs that patients/clients may have. Despite differences in treatment approaches, most participants agreed that their workplaces could benefit from efforts to create a safe and affirming space for people who use drugs, particularly TGD patients/clients. CONCLUSION Results underscore how structural, interpersonal, and individual factors contributed to barriers in the provision of gender-affirmative substance use-related care for TGD people. Findings can inform efforts to increase the capacity of providers to deliver gender-affirmative substance use-related services, which is essential to supporting the recovery goals of TGD people.
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Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA; Center for Promotion and Health Equity, Brown University, Box G-S121-4, Providence, RI, 02912, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
| | - Hill L Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Haley Adrian
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30329, USA
| | - Landon D Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 415 Washington Heights, Ann Arbor, MI, 48109, USA; Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI, 48104, USA
| | - Yohansa Fernández
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA; Warren Alpert School of Medicine, for Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Victoria Briody
- Warren Alpert School of Medicine, for Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Paige Matthews
- Pacific University, 2043 College Way, Forest Grove, OR, 97116, USA
| | - Patrick J A Kelly
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
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Malek R, Sarmiento M, Lamos E. Challenges of Gender-Affirming Care in Incarcerated Transgender People. Endocrinol Metab Clin North Am 2023; 52:677-687. [PMID: 37865481 DOI: 10.1016/j.ecl.2023.05.007] [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] [Indexed: 10/23/2023]
Abstract
Social and health disparities among transgender people may result in increased rates of incarceration, particularly among Black transgender women. The World Professional Association for Transgender Health states that all recommendations for gender-affirming care made in the Standards of Care-8 be applied equally to people living in institutions. Understanding the structural challenges to gender-affirming care in the corrections environment will allow the endocrinologist to navigate the complex correctional health care system. The barriers to gender-affirming care and surgery will be highlighted in this article.
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Affiliation(s)
- Rana Malek
- University of Maryland School of Medicine, 800 Linden Avenue, 8th Floor UMCDE, Baltimore, MD 21201, USA.
| | - Mauro Sarmiento
- YesCare Corporation, 7240 Parkway Drive, Suite 350, Hanover, MD 21076, USA
| | - Elizabeth Lamos
- University of Maryland School of Medicine, 800 Linden Avenue, 8th Floor UMCDE, Baltimore, MD 21201, USA
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Engelberg R, Hood Q, Shah K, Parent B, Martin J, Turpin R, Feelemyer J, Khan M, Vieira D. Challenges Unique to Transgender Persons in US Correctional Settings: a Scoping Review. J Urban Health 2023; 100:1170-1189. [PMID: 37851317 PMCID: PMC10728397 DOI: 10.1007/s11524-023-00794-z] [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] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
US correctional facilities operate under a binary interpretation of gender, which can yield inherent risks and conflicts for incarcerated transgender people. We conducted a scoping literature review on challenges unique to transgender individuals within US correctional settings. Online databases were searched to identify papers that addressed the challenges of incarcerated transgender adults age 18 + within US correctional institutions. A concurrent analysis of legal literature was reviewed with key policy recommendations extracted. A total of 33 papers (21 scientific studies and 12 legal analyses) met criteria for inclusion. Of the 21 scientific studies, the majority of papers (n = 14) focused on transgender women and most (n = 13) utilized qualitative methods. Emerging themes revealed challenges in key domains of violence, health, healthcare access, housing, and a pervasive culture of transphobia. Legal analyses supported policy changes such as implementing case-by-case housing classification systems, providing all forms of gender-affirming care, and safeguarding gender expression. Transgender persons face distinct obstacles while incarcerated in US correctional facilities and are in need of expanded protections. Working in tandem with efforts to decarcerate and reduce criminal legal involvement, widespread institutional policy change, such as redefining housing assignment policies, ensuring gender-affirming healthcare, and expanding transgender-specific competency trainings for correctional staff, is necessary.
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Affiliation(s)
- Rachel Engelberg
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Quinn Hood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Krina Shah
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Brendan Parent
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Rodman Turpin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Dorice Vieira
- Health Sciences Library, New York University Grossman School of Medicine, New York, NY, USA
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Lelutiu-Weinberger C, Clark KA, Pachankis JE. Mental Health Provider Training to Improve LGBTQ Competence and Reduce Implicit and Explicit Bias: A Randomized Controlled Trial of Online and In-Person Delivery. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2023; 10:589-599. [PMID: 38239562 PMCID: PMC10794005 DOI: 10.1037/sgd0000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals in most countries face strong stigma and often rely on affirmative mental health care to foster coping and resilience. We tested an LGBTQ-affirmative mental health training for psychologists and psychiatrists by comparing in-person versus online modalities and the added benefit of supervision. Participants were randomized to a two-day training either in-person (n = 58) or via live-stream online broadcast (n = 55). Outcomes were assessed at baseline and 5, 10, and 15 months posttraining. Optional monthly online supervision was offered (n = 47) from months 5 to 15. Given the substantial need for LGBTQ-affirmative expertise in high-stigma contexts, the training took place in Romania, a Central-Eastern European country with some of the highest LGBTQ stigma in Europe. Participants (M age = 35.1) were mostly cisgender female (88%) and heterosexual (85%). Trainees, regardless of whether in-person or online, reported significant decreases from baseline to 15-month follow-up in implicit and explicit bias and significant increases in LGBTQ-affirmative clinical skills, beliefs, and behaviors. LGBTQ-affirmative practice intentions and number of LGBTQ clients did not change. Participants who attended at least one supervision session demonstrated greater reductions in explicit bias and increases in LGBTQ-affirmative behaviors from baseline to 15-month follow-up than participants who did not attend supervision. LGBTQ-affirmative mental health training can efficiently and sustainably improve LGBTQ competence and reduce provider bias in high-stigma contexts. Future research can identify additional ways to encourage mental health providers' outreach to LGBTQ clients in need of affirmative care.
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Affiliation(s)
- Corina Lelutiu-Weinberger
- Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey
| | - Kirsty A. Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health
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Van Deinse TB, Zielinski MJ, Holliday SB, Rudd BN, Crable EL. The application of implementation science methods in correctional health intervention research: a systematic review. Implement Sci Commun 2023; 4:149. [PMID: 38001546 PMCID: PMC10675852 DOI: 10.1186/s43058-023-00521-4] [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: 08/03/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Improving access to high-quality healthcare for individuals in correctional settings is critical to advancing health equity in the United States. Compared to the general population, criminal-legal involved individuals experience higher rates of chronic health conditions and poorer health outcomes. Implementation science frameworks and strategies offer useful tools to integrate health interventions into criminal-legal settings and to improve care. A review of implementation science in criminal-legal settings to date is necessary to advance future applications. This systematic review summarizes research that has harnessed implementation science to promote the uptake of effective health interventions in adult criminal-legal settings. METHODS A systematic review of seven databases (Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Social Work Abstracts, ProQuest Criminal Justice Database, ProQuest Sociological Abstracts, MEDLINE/PubMed) was conducted. Eligible studies used an implementation science framework to assess implementation outcomes, determinants, and/or implementation strategies in adult criminal-legal settings. Qualitative synthesis was used to extract and summarize settings, study designs, sample characteristics, methods, and application of implementation science methods. Implementation strategies were further analyzed using the Pragmatic Implementation Reporting Tool. RESULTS Twenty-four studies met inclusion criteria. Studies implemented interventions to address infectious diseases (n=9), substance use (n=6), mental health (n=5), co-occurring substance use and mental health (n=2), or other health conditions (n=2). Studies varied in their operationalization and description of guiding implementation frameworks/taxonomies. Sixteen studies reported implementation determinants and 12 studies measured implementation outcomes, with acceptability (n=5), feasibility (n=3), and reach (n=2) commonly assessed. Six studies tested implementation strategies. Systematic review results were used to generate recommendations for improving implementation success in criminal-legal contexts. CONCLUSIONS The focus on implementation determinants in correctional health studies reflects the need to tailor implementation efforts to complex organizational and inter-agency contexts. Future studies should investigate policy factors that influence implementation success, design, and test implementation strategies tailored to determinants, and investigate a wider array of implementation outcomes relevant to criminal-legal settings, health interventions relevant to adult and juvenile populations, and health equity outcomes. TRIAL REGISTRATION A study protocol (CRD42020114111) was registered with Prospero.
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Affiliation(s)
- Tonya B Van Deinse
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, USA.
| | - Melissa J Zielinski
- University of Arkansas for Medical Sciences Psychiatric Research Institute, Little Rock, USA
| | | | | | - Erika L Crable
- Department of Psychiatry, University of California San Diego, San Diego, USA
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Daken K, Excell T, Clark KA, Hughto JMW, Sanders T, Debattista J, du Plessis C, Mullens AB, Phillips TM, Gildersleeve J, Brömdal A. Correctional staff knowledge, attitudes and behaviors toward incarcerated trans people: A scoping review of an emerging literature. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:149-166. [PMID: 38681490 PMCID: PMC11044747 DOI: 10.1080/26895269.2023.2265386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background: Trans people are incarcerated at disproportionately high rates relative to cisgender people and are at increased risk of negative experiences while incarcerated, including poor mental health, violence, sexual abuse, dismissal of self-identity, including poor access to healthcare. Aims: This scoping review sought to identify what is known about the knowledge, attitudes, and behaviors of correctional staff toward incarcerated trans people within the adult and juvenile justice systems. Method: This scoping review was conducted in accordance with the five-stage iterative process developed by Arksey and O'Malley (2005), utilizing the PRISMA guidelines and checklist for scoping reviews and included an appraisal of included papers. A range of databases and grey literature was included. Literature was assessed against predetermined inclusion and exclusion criteria, with included studies written in English, online full text availability, and reported data relevant to the research question. Results: Seven studies were included with four using qualitative methodologies, one quantitative, and two studies employing a mixed methods approach. These studies provided insights into the systemic lack of knowledge and experience of correctional staff working with trans people, including staff reporting trans issues are not a carceral concern, and carceral settings not offering trans-affirming training to their staff. Within a reform-based approach these findings could be interpreted as passive ignorance and oversights stressing the importance of organizational policies and leadership needing to set standards for promoting the health and wellbeing of incarcerated trans persons. Conclusions: From a transformational lens, findings from this study highlight the urgent need to address the underlying structural, systemic, and organizational factors that impact upon the knowledge, attitudes, and behaviors staff have and hold in correctional, and other health and community settings to meaningfully and sustainably improve health, wellbeing, and gender-affirming treatment and care for trans communities, including make possible alternative methods of accountability for those who do harms.
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Affiliation(s)
- Kirstie Daken
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Tarra Excell
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Kirsty A. Clark
- Department of Medicine, Health & Society, Institute for Public Policy Studies, Vanderbilt University, Nashville, Tennessee, USA
| | - Jaclyn M. W. Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown School of Public Health, Centre for Health Equity Research, Brown University, Providence, Rhode Island, USA
| | - Tait Sanders
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Carol du Plessis
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Amy B. Mullens
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Tania M. Phillips
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Jessica Gildersleeve
- School of Humanities and Communication, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Annette Brömdal
- School of Education, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
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Yu H, Flores DD, Bonett S, Bauermeister JA. LGBTQ + cultural competency training for health professionals: a systematic review. BMC MEDICAL EDUCATION 2023; 23:558. [PMID: 37559033 PMCID: PMC10410776 DOI: 10.1186/s12909-023-04373-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/17/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals' lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes. METHODS Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting. RESULTS 75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest-posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 - 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 - 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 - 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 - 1.11). CONCLUSIONS The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals' cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Dalmacio Dennis Flores
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
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11
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Wall CSJ, Patev AJ, Benotsch EG. Trans broken arm syndrome: A mixed-methods exploration of gender-related medical misattribution and invasive questioning. Soc Sci Med 2023; 320:115748. [PMID: 36736052 DOI: 10.1016/j.socscimed.2023.115748] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
RATIONALE Gender-related medical misattribution and invasive questioning (GRMMIQ), colloquially known as "trans broken arm syndrome," is a form of medical discrimination faced by transgender and gender diverse (TGD) patients wherein a provider incorrectly assumes that a medical condition results from a patient's gender identity or medical transition. This phenomenon may take one of two forms: (1) the incorrect and explicit misattribution of gender identity or medical transition as being the cause of an acute complaint, or (2) invasive and unnecessary questions regarding a patient's gender identity or gender transition status. OBJECTIVE Using mixed-methods procedures, this study aims to explore the incidence, some common correlates, and manifestations of GRMMIQ. METHODS American TGD participants (N = 147), recruited through an online recruitment platform, completed questions assessing their experiences in the healthcare system including lifetime incidence of GRMMIQ, outness to healthcare providers, and additional experiences of gender-related discrimination in a medical setting. Participants who indicated experiences of GRMMIQ were asked open-ended questions about one such experience. RESULTS Nearly one-third of participants reported experiencing GRMMIQ. Experiences were associated with outness to acute care providers and other types of gender-related discrimination in healthcare settings. Analysis of qualitative data revealed four primary themes: (1) assumptions of disordered thinking and being, (2) hyperfocus on aspects of medical transition, (3) cultural ignorance and incompetence, and (4) dismissiveness of the patient. CONCLUSION Together, these results enhance the understanding of an underexplored aspect of medical discrimination faced by TGD individuals while highlighting commonalities across different experiences.
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Affiliation(s)
- Catherine S J Wall
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Alison J Patev
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
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12
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Valente PK, Paine EA, Mellman W, Rael CT, MacCrate C, Bockting WO. Positive patient-provider relationships among transgender and nonbinary individuals in New York City. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:247-262. [PMID: 37114109 PMCID: PMC10128430 DOI: 10.1080/26895269.2022.2136814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background: Transgender and nonbinary (TGNB) individuals have diverse health needs and may face disproportionate barriers to healthcare, including developing positive patient-provider relationships. While there is mounting evidence of gender-based stigma and discrimination in healthcare, little is known about how TGNB individuals develop positive patient-provider relationships. Aims: To examine TGNB individuals' interactions with healthcare providers and identify main characteristics of positive patient-providers relationships. Methods: We conducted semi-structured interviews with a purposive sample of 13 TGNB individuals in New York, NY. Interviews were transcribed verbatim and analyzed inductively for themes related to characteristics of positive and trusting relationships with healthcare providers. Results: Participants' mean age was 30 years (IQR = 13 years) and most participants were nonwhite (n = 12, 92%). Receiving peer referrals to specific clinics or providers helped many participants find providers perceived to be competent and created initial grounds for positive patient-provider relationships. Providers with whom participants had positive relationships commonly managed primary care and gender-affirming care and relied on a network of interdisciplinary providers for other specialized care. Providers who were positively evaluated were perceived to possess in-depth clinical knowledge on the issues they were responsible for managing, including gender-affirming interventions, particularly for TGNB patients who perceived themselves to be knowledgeable about TGNB-specific care. Provider and staff cultural competence and a TGNB-affirming clinic environment were also important, particularly early in the patient-provider relationship, and if combined with TGNB clinical competence. Discussion: Provider-focused training and education programs should combine components of TGNB clinical and cultural competence to facilitate development of positive relationships between TGNB patients and providers, thereby improving the health and wellbeing of TGNB people.
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Affiliation(s)
- Pablo K. Valente
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, Connecticut, USA
| | - Emily Allen Paine
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - William Mellman
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Christine T. Rael
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Caitlin MacCrate
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
| | - Walter O. Bockting
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York, USA
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13
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Rioux C, Paré A, London-Nadeau K, Juster RP, Weedon S, Levasseur-Puhach S, Freeman M, Roos LE, Tomfohr-Madsen LM. Sex and gender terminology: a glossary for gender-inclusive epidemiology. J Epidemiol Community Health 2022; 76:jech-2022-219171. [PMID: 35725304 DOI: 10.1136/jech-2022-219171] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/07/2022] [Indexed: 01/05/2023]
Abstract
There is increased interest in inclusion, diversity and representativeness in epidemiological and community health research. Despite this progress, misunderstanding and conflation of sex and gender have precluded both the accurate description of sex and gender as sample demographics and their inclusion in scientific enquiry aiming to distinguish health disparities due to biological systems, gendered experiences or their social and environmental interactions. The present glossary aims to define and improve understanding of current sex-related and gender-related terminology as an important step to gender-inclusive epidemiological research. Effectively, a proper understanding of sex, gender and their subtleties as well as acknowledgement and inclusion of diverse gender identities and modalities can make epidemiology not only more equitable, but also more scientifically accurate and representative. In turn, this can improve public health efforts aimed at promoting the well-being of all communities and reducing health inequities.
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Affiliation(s)
- Charlie Rioux
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ash Paré
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Kira London-Nadeau
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Pediatric Research Centre, Montreal, Quebec, Canada
| | - Robert-Paul Juster
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Quebec, Canada
- Montreal Mental Health University Institute Research Centre, Montreal, Quebec, Canada
- Centre on Sex*Gender, Allostasis, and Resilience, Montreal, Quebec, Canada
| | - Scott Weedon
- Department of English, Texas Tech University, Lubbock, Texas, USA
| | | | - Makayla Freeman
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Educational and Counselling Psychology and Special Education, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Educational and Counselling Psychology and Special Education, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
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14
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Willie TC, Sharpless L, Monger M, Kershaw TS, Mahoney WB, Stockman JK. Enhancing domestic violence advocates' ability to discuss HIV pre-exposure prophylaxis (PrEP): Feasibility and acceptability of an educational intervention. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065211070548. [PMID: 35001751 PMCID: PMC8744168 DOI: 10.1177/17455065211070548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Survivors of intimate partner violence are at elevated risk for HIV acquisition, yet there is limited research on the best strategies to optimize biomedical HIV prevention, such as pre-exposure prophylaxis among this population. Domestic violence agencies are critical collaborating partners and function as potential entry points into HIV prevention services for survivors; however, limited knowledge regarding HIV prevention has been an important barrier to advocate-led discussions. This study aimed to develop, implement, and evaluate an HIV prevention intervention for domestic violence advocates. SETTING A nonrandomized, group-based intervention with pre-intervention, immediate post-intervention, and 3-month post-intervention periods were conducted with multiple domestic violence agencies in Mississippi. METHODS Overall, 25 domestic violence advocates participated in the two-session intervention. Surveys were administered to assess pre-exposure prophylaxis knowledge, self-efficacy, subjective norms, and willingness to provide HIV prevention services to intimate partner violence survivors. Generalized estimating equations were conducted to assess change in behavioral outcomes over time. RESULTS Compared to pre-intervention, there were significant increases at immediate and 3-month post-intervention in advocates' intervention acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to provide HIV prevention information, discuss pre-exposure prophylaxis eligibility criteria, assist pre-exposure prophylaxis-engaged clients, and initiate pre-exposure prophylaxis counseling. CONCLUSION This group-based intervention enhanced domestic violence advocates' acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to offer HIV care information, discuss pre-exposure prophylaxis eligibility, assist pre-exposure prophylaxis-engaged survivors, and initiate pre-exposure prophylaxis counseling with intimate partner violence survivors. Efforts should focus on training domestic violence advocates in HIV prevention care for survivors and also include these agencies in collaborative strategies to reduce HIV incidence.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurel Sharpless
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Mauda Monger
- MLM Center for Health Education and
Equity Consulting Services, Jackson, MS, USA
| | - Trace S Kershaw
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Wendy B Mahoney
- Mississippi Coalition Against Domestic
Violence, Jackson, MS, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and
Global Public Health, Department of Medicine, University of California San Diego, La
Jolla, CA, USA
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15
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Trans-affirming care: An integrative review and concept analysis. Int J Nurs Stud 2021; 123:104047. [PMID: 34454333 DOI: 10.1016/j.ijnurstu.2021.104047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 05/23/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Contemporary healthcare exists within a cisnormative landscape which underpins the erasure of trans persons in healthcare, health research, and health education, and results in negative experiences and poorer outcomes. Further, nurses report feeling inadequately prepared to provide affirming care to trans patients, with little guidance available to inform their practice. OBJECTIVE To explore the conceptual understanding of trans-affirming care as it pertains to nursing, and to provide recommendations for trans-affirming nursing care at the systemic, organizational, and individual level. METHODS A systematic search of the literature was completed using standard review processes. Two reviewers independently applied a two-step study selection procedure to identify eligible citations. Walker and Avant's concept analysis method was used to analyze the extracted data to determine antecedents, defining attributes, empirical referents, and consequences. RESULTS Of the 5914 studies, 136 met criteria, representing a variety of clinical settings. The antecedents identified were depathologization of gender variance and cultural humility. The defining attributes were patient-led care, trans-affirming culture, and trans-competent providers. The consequences were improved psychological and physical health outcomes. CONCLUSIONS Trans persons and communities are becoming more visible in society, as are their testimonials about their substandard treatment within healthcare systems. Nurses need to respond to these health inequities with self-reflection, advocacy, and education. At the center of this work is the concept of trans-affirming care, which is a philosophy of care specific to trans persons. Tweetable abstract: This article offers an evidence-informed definition of trans-affirming care and recommendations for how it can be operationalized by nurses.
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16
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The Impact of Training in Transgender Care on Healthcare Providers Competence and Confidence: A Cross-Sectional Survey. Healthcare (Basel) 2021; 9:healthcare9080967. [PMID: 34442104 PMCID: PMC8391671 DOI: 10.3390/healthcare9080967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022] Open
Abstract
All studies to date demonstrate a lack of access to care for transgender people. A few educational efforts in providing care to transgender people have been successful. However, one challenge in administering training is that there is almost no research on the need of healthcare providers (HCP) to acquire knowledge, as well as on the effect of training on their level of competence and confidence in working with transgender people. Results from an online survey of a convenience sample of HCP across four different European countries (N = 810) showed that 52.7% reported experiences with some form of training on transgender people. The mean confidence level for all HCP (with or without training) in working with transgender people was 2.63, with a significant effect of training on confidence. 92.4% of HCP believed that training would raise their competence, and this belief was significantly higher among HCP with training experience, HCP working in Serbia and Sweden and/or among those HCP who belong to a sexual minority group. General practitioners had the lowest confidence levels of all professions involved. The study provided strong support for the use of training in improving healthcare conditions for transgender people, not only to raise awareness among HCP, but also to increase knowledge, competence and confidence levels of HCP in working with transgender people.
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17
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Riggs DW. Evaluating outcomes from an Australian webinar series on affirming approaches to working with trans and non-binary young people. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1902747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Damien W. Riggs
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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18
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Harvey TD, Keene DE, Pachankis JE. Minority stress, psychosocial health, and survival among gay and bisexual men before, during, and after incarceration. Soc Sci Med 2021; 272:113735. [DOI: 10.1016/j.socscimed.2021.113735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/08/2020] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
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19
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Taracuk MD, Koch JM. Use of a media intervention to increase positive attitudes toward transgender and gender diverse individuals. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:86-98. [PMID: 36713142 PMCID: PMC9879171 DOI: 10.1080/26895269.2021.1878479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND As issues related to transgender and gender diverse individuals gain more national media attention, professional organizations that promote mental health and LGBTQ + rights continue to advocate for equality and inclusion. Barriers to equality and inclusion for transgender and gender diverse individuals can include a variety of factors including discrimination in educational and workplace settings, and issues related to housing, poverty, and homelessness. AIM To examine the impact of a media intervention on changing attitudes toward transgender and gender diverse individuals. METHODS A total of 223 students from a large, Midwestern university in the USA participated and received a 45-minute media intervention along with pre- and post-testing. RESULTS A split-plot factorial ANOVA to investigate potential differences in attitudes and beliefs toward transgender and gender diverse individuals using the Transgender Attitude and Beliefs Scale indicated a statistically significant interaction based on a media intervention where F(1, 109) = 7.042, p = .009. A split-plot factorial ANOVA to investigate potential differences in willingness to engage in social action on behalf of this population measured by the Social Justice Scale did not indicate a statistically significant interaction based on the media intervention where F(1, 109) = .881, p = .350. CONCLUSION These findings suggest that a variety of potential media interventions can increase positive attitudes and beliefs toward marginalized groups, but a stronger and/or additional intervention is needed for participants to engage in social action on behalf of the group. Implications and limitations of the study are discussed.
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Affiliation(s)
- Mark D. Taracuk
- Counseling Center, Georgia Southern University, Statesboro, GA, USA
| | - Julie M. Koch
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, OK, USA
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Abstract
PURPOSE OF REVIEW Transgender (trans) populations are heavily impacted by HIV, yet face structural, social, and individual barriers to engagement in HIV prevention and care. In this review, we summarize the data on barriers and facilitators and discuss evidence-informed strategies to facilitate access to and engagement in HIV prevention and care by trans communities. RECENT FINDINGS Intersectional stigma and discrimination at structural, community, individual levels present substantial impediments to HIV prevention and optimal care. Access to gender-affirming health care is a priority for trans communities. Where trans communities are highly networked, these networks may provide a strong infrastructure for disseminating HIV innovations and reaching individuals who are not engaged in HIV services. Efforts to engage trans people in HIV prevention and care must address stigma, provide gender-affirming services, and build on community strengths and priorities to ensure trans populations achieve maximum benefit from advances in HIV prevention and care. SUMMARY Combination approaches that respond to the complex drivers of HIV in trans communities represent promising strategies for engaging trans people and their partners in HIV prevention and care.
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21
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Van Hout MC, Kewley S, Hillis A. Contemporary transgender health experience and health situation in prisons: A scoping review of extant published literature (2000-2019). INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:258-306. [PMID: 34993510 PMCID: PMC8726645 DOI: 10.1080/26895269.2020.1772937] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Many jurisdictions globally have no specific prison policy to guide prison management and prison staff in relation to the special needs of lesbian, gay, bisexual and transgender (LGBT) prisoners despite the United Nations for the Treatment of Prisoners Standard Minimum Rules and the updated 2017 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Within LGBT prison groups, transgender people represent a key special population with distinct needs and rights, with incarceration rates greater than that of the general population, and who experience unique vulnerabilities in prisons. Aims/Method: A scoping review was conducted of extant information on the transgender prison situation, their unique health needs and outcomes in contemporary prison settings. Fifty-nine publications were charted and thematically analyzed. Results: Five key themes emerged: Transgender definition and terminology used in prison publications; Prison housing and classification systems; Conduct of correctional staff toward incarcerated transgender people; Gender affirmation, health experiences and situational health risks of incarcerated transgender people; and Transgender access to gender-related healthcare in prison. Conclusions: The review highlights the need for practical prison based measures in the form of increased advocacy, awareness raising, desensitization of high level prison management, prison staff and prison healthcare providers, and clinical and cultural competence institutional training on transgender patient care. The review underscores the need to uphold the existing international mandates to take measures to protect incarcerated transgender people from violence and stigmatization without restricting rights, and provide adequate gender sensitive and gender affirming healthcare, including hormone therapy and gender reassignment.
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Affiliation(s)
- Marie Claire Van Hout
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Stephanie Kewley
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Alyson Hillis
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
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22
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Ledesma E, Ford CL. Health Implications of Housing Assignments for Incarcerated Transgender Women. Am J Public Health 2020; 110:650-654. [PMID: 32191518 DOI: 10.2105/ajph.2020.305565] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transgender women (i.e., persons who were assigned male sex at birth but who live and identify as female) experience forms of discrimination that limit their access to stable housing and contribute to high rates of incarceration; once incarcerated, the approaches used to assign them housing within the jail or prison place them at risk for abuse, rape, and other outcomes. Yet, a paucity of studies explores the implications of carceral housing assignments for transgender women.Whether the approaches used to assign housing in jails and prisons violate the rights of incarcerated transgender persons has been argued before the US federal courts under Section 1983 of the US Constitution, which allows persons who were raped while incarcerated to claim a violation of their Eighth Amendment rights.Reforms and policy recommendations have been attempted; however, the results have been mixed and the public health implications have received limited attention.
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Affiliation(s)
- Elida Ledesma
- Elida Ledesma is with the Arts for Incarcerated Youth Network and at the start of this project was with the Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles. Chandra L. Ford is with the Center for the Study of Racism, Social Justice & Health, Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles
| | - Chandra L Ford
- Elida Ledesma is with the Arts for Incarcerated Youth Network and at the start of this project was with the Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles. Chandra L. Ford is with the Center for the Study of Racism, Social Justice & Health, Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles
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Do TT, Nguyen ATV. 'They know better than we doctors do': providers' preparedness for transgender healthcare in Vietnam. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2020; 29:92-107. [PMID: 33411663 DOI: 10.1080/14461242.2020.1715814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 01/08/2020] [Indexed: 06/12/2023]
Abstract
While recognition of transgender people has increased in Vietnam, this population continues to face significant stigma and discrimination within their families and in public, including in medical settings. Understanding of transgender health is limited, especially regarding the provision of care to transgender people. This paper explores providers' preparedness for delivering transgender care using data from qualitative interviews with twelve healthcare professionals in Hanoi and Ho Chi Minh City. Drawing on the socio-ecological model, we illustrated multi-level factors that influenced the provision of medical services to transgender people, including restrictive legislation (policy level); shortage of transgender-specific services, and lack of training and guidelines (organisational level); and ambiguous perceptions, inappropriate provider-patient communication, and medical knowledge gaps (individual level). Overall, our study has identified a healthcare environment that is under-prepared to meet the complex health needs of transgender individuals. With this study, we call for intervention strategies beyond individual-level support and emphasise the urgency of allowing medical institutions to provide transgender-specific health services including gender-affirming surgery and hormonal treatments.
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Affiliation(s)
- Trang Thu Do
- School of Social Sciences, Faculty of Arts, Monash University, Clayton, Australia
- Research Department, Institute for Social Development Studies, Hanoi, Vietnam
| | - Anh T Van Nguyen
- Research Department, Institute for Social Development Studies, Hanoi, Vietnam
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24
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Stryker SD, Pallerla H, Pickle S. Considerations on medical training for gender-affirming care: Motivations and perspectives. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2019; 21:79-88. [PMID: 33015661 PMCID: PMC7430477 DOI: 10.1080/15532739.2019.1689880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Background: Many transgender individuals lack access to needed medical care, partially due to a lack of providers with experience in gender-affirming healthcare. Aims: The purpose of this study was to identify professional motivators for medical providers seeking out training in gender-affirming care and to define which training experiences were most beneficial to their career development. By identifying experienced providers' recommendations on which training modalities are most relevant to their practice, we aim to suggest future directions for medical education initiatives to effectively expand the transgender care workforce. Methods: A voluntary cross-sectional electronic survey was distributed through professional listservs and publicly-available referral lists to interdisciplinary providers who self-identified as having experience in providing care to transgender individuals. Results: One hundred and fifty-three (n = 153) physicians, physician assistants, or advance-practice nurses responded to the survey. The majority (96.7%) were located in the United States, representing 37 states. The two most common motivators for seeking out training in gender-affirming care were filling a need in the community (73.0%) and/or having met a transgender-identified person in a clinical setting who requested care (63.8%). While many providers gained skills independently (57.3%), the two most commonly-available training opportunities were professional conferences (57.3%) and mentorship (41.3%). Respondents were most likely to recommend that others in their field be trained via structured clinical experience (e.g., a rotation or longitudinal exposure during training), rather than additional didactic training. Discussion: This study identifies key high-yield training methodologies which could improve access to quality gender-affirming healthcare. Through integration of structured clinical experiences during training, direct clinical mentorship, and professional development at conferences on gender-affirming care, the workforce of welcoming and prepared healthcare providers for transgender patients will increase. This will lead to a tremendous improvement on access to gender-affirming care in our communities.
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Affiliation(s)
- Shanna Duffy Stryker
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Harini Pallerla
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah Pickle
- Department of Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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25
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White Hughto JM, Clark KA. Designing a Transgender Health Training for Correctional Health Care Providers: A Feasibility Study. THE PRISON JOURNAL 2019; 99:329-342. [PMID: 31198227 PMCID: PMC6563323 DOI: 10.1177/0032885519837237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Limited provider knowledge on transgender health contributes to stigmatizing interactions and access-to-care challenges for incarcerated transgender people. Drawing on interviews with recently incarcerated transgender individuals and correctional staff, we developed and piloted a transgender health training for correctional healthcare providers. Providers indicated that the training provided them with the requisite competencies to provide gender-affirming care to transgender patients. Participants also found the intervention to be highly acceptable and feasible and recommended that the training be provided to others. Additionally, results suggested that the training may be able to increase providers' transgender-related knowledge. Further testing of the intervention is warranted.
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Affiliation(s)
- Jaclyn M White Hughto
- Fenway Institute, Fenway Health, Boston, MA
- Yale School of Public Health, New Haven, CT
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26
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Hughto JMW, Reisner SL, Kershaw TS, Altice FL, Biello KB, Mimiaga MJ, Garofalo R, Kuhns LM, Pachankis JE. A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health (Oxf) 2019; 41:100-109. [PMID: 29474682 PMCID: PMC6490767 DOI: 10.1093/pubmed/fdy031] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/04/2018] [Accepted: 01/31/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Transgender women are disproportionately incarcerated in the US relative to the general population. A dearth of research has explored the factors that predict incarceration among transgender women or the longitudinal impact of incarceration on the health of this population. METHODS Between 2012 and 2015, 221 transgender women ages 16-29 from Boston, MA and Chicago, IL were prospectively assessed at baseline, 4, 8 and 12 months. Mixed effects models were used to identify risk factors for incarceration and examine whether incarceration predicts somatic, anxiety and depressive symptoms, illicit drug use, and binge drinking over time, controlling for baseline psychiatric and substance use disorders. RESULTS Overall, 38% experienced incarceration, before (33%) and during (18%) the study period. Significant independent predictors of recent incarceration included sex work, recent homelessness, school dropout and number of times incarcerated prior to enrollment while recent incarceration significantly predicted somatic symptoms and illicit drug use over time. CONCLUSIONS Incarceration burden is high in young transgender women. Both structural and individual risk factors predict incarceration and poor health, suggesting the need for multilevel interventions to prevent incarceration and support young transgender women during incarceration and upon release.
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Affiliation(s)
- Jaclyn M White Hughto
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Pediatrics, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
- Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Trace S Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Fredrick L Altice
- Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Katie B Biello
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry & Human Behavior, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Pediatrics and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John E Pachankis
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Pachankis JE. The scientific pursuit of sexual and gender minority mental health treatments: Toward evidence-based affirmative practice. AMERICAN PSYCHOLOGIST 2018; 73:1207-1219. [PMID: 30525805 PMCID: PMC6291842 DOI: 10.1037/amp0000357] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The time has arrived for psychological science to translate the accumulating empirical research regarding sexual and gender minority (SGM) mental health into evidence-based affirmative treatments for this population. Far from the unscientific, homophobic theories of the early 20th century, several recent efforts in psychological science are starting to pave the way for evidence-based SGM-affirmative mental health treatments. These efforts include (a) identifying clear treatment targets for SGM, (b) conducting treatment studies that test the efficacy of therapy for SGM populations, (c) increased reporting of sexual orientation and gender diversity in existing randomized controlled trials conducted with the general population, and (d) reducing stigma itself, which has heretofore impeded the resources necessary to produce scientific evidence about SGM-affirmative treatments. This article reviews this progress and outlines future research directions needed to advance evidence-based practice for SGM, including determining whether and how existing evidence-based treatments need to be adapted to address SGM-specific concerns, why SGM-affirmative treatments work, and for whom and under what conditions SGM-affirmative treatments work best. A program of research is described that attempts to address these questions through randomized controlled trials with strong comparison conditions, psychotherapy process research of current SGM-affirmative practice, and tests of treatment moderators. To the extent that the mental health profession continues to pursue these solutions, it can ensure the continued flourishing of this population, whose visibility and vibrancy likely represent the surest route toward improving public acceptance and therefore its future mental health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health
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Hughto JMW, Pachankis JE, Reisner SL. Healthcare Mistreatment and Avoidance in Trans Masculine Adults: The Mediating Role of Rejection Sensitivity. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2018; 5:471-481. [PMID: 30637266 DOI: 10.1037/sgd0000296] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objectives Given that prior mistreatment can lead to heightened vigilance to and perceptions of future rejection, the present study examined whether this heightened vigilance, known as rejection sensitivity, mediates the association between healthcare mistreatment and healthcare avoidance in trans masculine (TM) adults. Method Between 2015 and 2016, 150 TM adults completed a comprehensive survey assessing socio-demographics, sexual health, and healthcare experiences. A 5-item scale assessing participants' sensitivity to rejection in healthcare scenarios was administered and psychometrically evaluated. Structural equation modeling was used to test whether rejection sensitivity in healthcare mediated the relationship between lifetime mistreatment in healthcare and past 12-month healthcare avoidance among TM adults. Results Overall, 68% of participants had experienced some form of mistreatment in healthcare in their lifetime and 43% had avoided healthcare in the past 12 months. For 5% of the sample, healthcare avoidance in the past 12 months resulted in a medical emergency. Path analyses revealed that healthcare mistreatment was positively correlated with rejection sensitivity and sensitivity was positively correlated with past 12-month healthcare avoidance. Rejection sensitivity mediated the relationship between mistreatment and healthcare avoidance (all p-values < 0.05). Conclusion Rejection sensitivity may contribute to healthcare avoidance among stigmatized TM patients; however, longitudinal research is needed to establish the temporal ordering of these processes. Multilevel interventions to reduce healthcare discrimination and help TM adults cope with the psychological and behavioral consequences of stigma are recommended.
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Affiliation(s)
- Jaclyn M W Hughto
- Departments of Epidemiology and Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI.,Center for Health Equity Research, Brown University, Providence, RI.,The Fenway Institute, Fenway Health, Boston, MA
| | - John E Pachankis
- Social Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA.,Department of Pediatrics, Boston Children's Hospital /Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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White Hughto JM, Clark KA, Altice FL, Reisner SL, Kershaw TS, Pachankis JE. Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women's healthcare experiences in sex-segregated jails and prisons. Int J Prison Health 2018; 14:69-88. [PMID: 29869582 PMCID: PMC5992494 DOI: 10.1108/ijph-02-2017-0011] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues. Design/methodology/approach In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated. Findings Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers' transgender bias, others attributed barriers to providers' limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants' health while incarcerated. Research limitations/implications Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women's access to quality, gender-affirmative healthcare. Originality/value This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women's acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.
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Affiliation(s)
- Jaclyn M White Hughto
- Departments of Epidemiology and Behavioral and Social Sciences at the Brown University School of Public Health , Providence, Rhode Island, USA
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Kirsty A Clark
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles , Los Angeles, California, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, Yale University , New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University , New Haven, Connecticut, USA
| | - Sari L Reisner
- Department of Epidemiology, Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Division of Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University , New Haven, Connecticut, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University , New Haven, Connecticut, USA
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Clark KA, White Hughto JM, Pachankis JE. "What's the right thing to do?" Correctional healthcare providers' knowledge, attitudes and experiences caring for transgender inmates. Soc Sci Med 2017; 193:80-89. [PMID: 29028559 PMCID: PMC5695233 DOI: 10.1016/j.socscimed.2017.09.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/15/2017] [Accepted: 09/30/2017] [Indexed: 12/19/2022]
Abstract
RATIONAL Incarcerated transgender individuals may need to access physical and mental health services to meet their general and gender-affirming (e.g., hormones, surgery) medical needs while incarcerated. OBJECTIVE This study sought to examine correctional healthcare providers' knowledge of, attitudes toward, and experiences providing care to transgender inmates. METHOD In 2016, 20 correctional healthcare providers (e.g., physicians, social workers, psychologists, mental health counselors) from New England participated in in-depth, semi-structured interviews examining their experiences caring for transgender inmates. The interview guide drew on healthcare-related interviews with recently incarcerated transgender women and key informant interviews with correctional healthcare providers and administrators. Data were analyzed using a modified grounded theory framework and thematic analysis. RESULTS Findings revealed that transgender inmates do not consistently receive adequate or gender-affirming care while incarcerated. Factors at the structural level (i.e., lack of training, restrictive healthcare policies, limited budget, and an unsupportive prison culture); interpersonal level (i.e., custody staff bias); and individual level (i.e., lack of transgender cultural and clinical competence) impede correctional healthcare providers' ability to provide gender-affirming care to transgender patients. These factors result in negative health consequences for incarcerated transgender patients. CONCLUSIONS Results call for transgender-specific healthcare policy changes and the implementation of transgender competency trainings for both correctional healthcare providers and custody staff (e.g., officers, lieutenants, wardens).
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Affiliation(s)
- Kirsty A Clark
- UCLA Fielding School of Public Health, Los Angeles, CA, USA.
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