Lesbian, Gay, Bisexual, and Transgender health: Creating safe spaces and caring for patients with cultural humility

Perceptions and willingness concerning the collection of sexual orientation and gender identity data in Australian healthcare services

Background Despite growing recognition of the importance of collecting sexual orientation and gender identity (SOGI) data to improve healthcare access and equity for LGBTQA+ populations, uncertainty remains around how these data are collected, their perceived importance and individuals' willingness to disclose such information in healthcare settings. The aim of this study was to understand perceptions of the collection of data on sexual orientation and gender identity in healthcare settings across Australia, and individuals' willingness to provide this data. Methods A cross-sectional online survey of 657 Australian residents was conducted to assess participants' attitudes towards SOGI data in healthcare settings, along with preferences for methods to collect these data. Statistical analyses included ANCOVA, Chi-squared tests and Wilcoxon signed-rank tests. Results Participants generally recognised the importance of the collection of basic demographic data to support the provision of health services. Willingness to share SOGI data varied, with significant differences noted across gender, sexual orientation and cultural backgrounds. LGBTQA+ participants expressed greater willingness to provide SOGI data, but only in contextually appropriate situations, and preferred more inclusive data collection methods. Conclusions The study shows a context-dependent willingness to provide SOGI data in health care, underscoring the need for sensitive data collection methods. Insights into SOGI data collection attitudes are vital for developing inclusive and respectful healthcare practices. Improved SOGI data collection can enrich healthcare outcomes for diverse groups, informing public health policies and practices tailored to LGBTQA+ needs.

Sexual and Gender Minority Migrants' Experiences of Health Service Access and Utilisation: A Qualitative Meta-Synthesis

AIMS

To describe and synthesise qualitative studies exploring sexual and gender minority migrants' experiences of health service access and utilisation.

DESIGN

Systematic meta-synthesis of qualitative studies.

DATA SOURCES

Systematic searches in four databases and citation screening were conducted in 2023 and 2024. English-language empirical qualitative studies published in scientific journals within 10 years were included. Of 1109 screened, 21 reports were included.

METHODS

Included reports were appraised using CASP and JBI checklists. Extracted results were analysed with inductive content analysis in a collaborative process.

RESULTS

All reports had acceptable quality, including 365 participants from 72 countries. A range of external and internal barriers to accessing health services were reported, including financial constraints and fears. Although migrants expressed an appreciation of health services, they also experienced non-affirming behaviours and discrimination related to their intersecting identities. Several essential components in health services necessary to cater to the needs of migrants were addressed, including the personality and manner of health professionals as well as adherence to confidentiality.

CONCLUSION

Barriers to health services, intersectional discrimination and non-affirming behaviours when interacting with health services are pressing issues that need further attention.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Ensuring safety through affirming support is key to achieving high-quality and accessible health services for sexual and gender minority migrants. Nurses and other health professionals need to carefully consider intersectional layers related to sensitivity and safety when supporting sexual and gender minority migrants. Open, friendly, validating, respectful and encouraging communication is essential in clinical settings.

IMPACT

This review addressed experiences of health services amongst a marginalised population. The findings highlight the importance of affirming care and are relevant for health professionals, stakeholders and decision-makers.

REPORTING METHOD

ENTREQ.

PATIENT OR PUBLIC CONTRIBUTION

Two persons with lived experience were involved in the meta-synthesis.

Discrimination in the medical setting among LGBTQ+ adults and associations with cancer screening

PURPOSE

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals experience disparities in cancer screening. We examined whether experience of LGBTQ+ -related discrimination in medical settings was associated with cancer screening disparities.

METHODS

Participants were recruited via social media for a cross-sectional survey study. Those who self-reported as LGBTQ+ , being 40+ years of age, and residing in the US were eligible. Participants reported their clinical and demographic characteristics, cancer screening history, and experiences of discrimination in a medical setting. We examined the odds (OR) of ever undergoing cancer screening by experienced discrimination, stratified by sex assigned at birth.

RESULTS

Participants (n = 310) were on average 54.4 ± 9.0 years old and primarily White (92.9%). Most identified as lesbian (38.1%) or gay (40.0%) while 17.1% were transgender or gender diverse. Nearly half (45.5%) reported experiencing LGBTQ+ -related discrimination in the medical setting. Participants assigned female at birth with discriminatory experiences had significantly lower odds of ever undergoing colonoscopy/sigmoidoscopy compared to those without discriminatory experiences (OR: 0.37; 95% Confidence Interval (CI) 0.15-0.90). No significant differences in colonoscopy/sigmoidoscopy uptake were observed in those assigned male at birth by discriminatory experiences (OR: 2.02; 95% CI 0.59-6.91). Pap tests, mammogram, and stool colorectal cancer screening did not differ by discriminatory experience.

CONCLUSION

Discrimination in medical settings was commonly reported by LGBTQ+ individuals in this study. When treating LGBTQ+ patients, clinicians should ask about prior experiences and continue to promote cancer screening. Future studies should examine discrimination as a key driver of LGBTQ+ disparities in cancer screening.

Cultural Humility in Nursing: A Concept Analysis

BACKGROUND

The ability of nurses to deliver culturally mindful health care may be vital to improving the patient-clinician relationship and subsequent health outcomes for marginalized populations. Continuing education in cultural training should be designed to enhance a nurse's cultural humility.

METHOD

This study explores the concept of nurse cultural humility using the methods outlined by Walker and Avant (2018): define the attributes, offer a model case exemplifying the attributes, discuss the antecedents and consequences, and determine empirical referents.

RESULTS

The defining attributes of cultural humility in nursing are a lifelong process of reflexivity, an understanding and appreciation that the cultural backgrounds of both nurse and patient influence health care encounters, and a commitment to redress and mitigate power imbalances in the patient-clinician relationship.

CONCLUSION

By clearly defining nurse cultural humility, leaders will be able to develop cultural training interventions to enhance nurse cultural humility and measure the concept accurately. [J Contin Educ Nurs. 2024;55(12):596-603.].

'A void in our community': exploring the complexities of delivering and implementing primary care services for transgender individuals in Northern Ontario

AIM

To understand how the implementation of primary care services for transgender individuals is undertaken and delivered by practitioners in Northern Ontario.

BACKGROUND

Northern Ontario, Canada, has a shortage of primary care health practitioners, and of these, there are a limited number providing transgender primary care. Transgender people in Northern Ontario must also negotiate a lack of allied and specialty services related to transgender health and travel over long distances to access those services that do exist.

METHODS

A convergent mixed methods design was guided by normalization process theory (NPT) to explore transgender primary care delivery and implementation by nurses, nurse practitioners, physicians, social workers, and psychotherapists. A survey measuring implementation processes was elaborated through qualitative interviews with participants. Analysis of key themes emerging using the NPT framework informed understanding of primary care successes, barriers, and gaps in Northern Ontario.

FINDINGS

Key themes included the need for more education on transgender primary care practice, increased need for training and awareness on transgender resources, identification of unique gaps and barriers to access in Northern Ontario transgender care, and the benefits of embedding and normalizing transgender care in clinical practice to practitioners and transgender patients. These findings are key to understanding and improving access and eliminating healthcare barriers for transgender people in Northern Ontario.

Measures of Health Care Providers' Knowledge, Clinical Skills, or Prejudice Toward Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Sexual and Gender Minority Populations: A Scoping Review

Purpose: Assessing health care providers' knowledge, clinical skills, and prejudice toward lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority populations (LGBTQIA+) can help identify areas for improvement in health care provider training. The aim of this study was to map the range of studies that report measures of health care providers' knowledge, clinical skills, or prejudice toward LGBTQIA+ populations. Methods: A scoping review adopting the Joanna Briggs Institute methodology was conducted. Electronic database searches were conducted in CINAHL via EBSCO Host, Epistemonikos, LILACS via Virtual Health Library Regional Portal, PubMed, Scopus, and Web of Sciences. The samples of other reviews were screened. Studies that validated, translated, and/or cross-culturally adapted measures of the knowledge, clinical skills, and prejudice of health care providers and students toward LGBTQIA+ individuals were selected. Scholars were consulted to ensure that no relevant studies were missing. Data were extracted by two independent reviewers and presented in tabular form along with narrative summaries. Results: This scoping review identified 27 measures that have been validated, translated, and/or adapted with health care providers or students as the target population, distributed across 33 studies. Conclusions: Psychometric studies involving LGBTQIA+ patients and health care professionals have increased in recent years, with North American countries being the most frequent location. However, a growing number of studies are being conducted in Latin American countries such as Brazil and Colombia.

Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care

BACKGROUND

Sexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population's health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings.

OBJECTIVE

To explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs.

DESIGN

Semi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018.

PARTICIPANTS

The study included a sample of 43 young adult SMM (ages 25-27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City.

APPROACH

Researchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts.

KEY RESULTS

Analyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants' identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers.

CONCLUSIONS

SMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients' preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.

An examination of nurse practitioner students' perceptions of knowledge, confidence, and experiences related to caring for lesbian, gay, bisexual, transgender, and queer or questioning patients: A national perspective

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals are significantly less likely to have a primary health care provider, be uninsured, and postpone medical care. A health care provider's lack of knowledge in LGBTQ+ health needs, low confidence in discussing sexuality, and bias can result in LGBTQ+ patients choosing to delay or avoid seeking care. These are missed opportunities for health care providers to recognize their unique needs, provide education and preventive screenings and care, and manage chronic conditions.

PURPOSE

The aim of this study was to examine nurse practitioner students' perceptions of knowledge, confidence, and experiences related to caring for LGBTQ+ patients.

METHODOLOGY

Using a descriptive, cross-sectional survey research design, a 29-item online survey was distributed through email to nurse practitioner students (n = 419) across the United States.

RESULTS

Overall, nurse practitioners (NP) students demonstrated infrequent questioning related to gender preferences, sexual terms, and clarification of relationships. Results showed that 77.9% of NP students within two terms of graduation had not received any LGBTQ+-specific training. Almost 75% of the NP students reported not routinely asking about sexuality, and 82% reported infrequently or never asking gender identity. Furthermore, 93.1% of respondents reported providers infrequently or never ask about preferred gender or pronouns, and 86% reported providers infrequently inquire about sexual identity in primary care visits.

CONCLUSIONS

Study findings demonstrate the uniqueness of managing care for LGBTQ+ patients and importance for more detailed LGBTQ+ health training in curricula in NP programs.

IMPLICATIONS

Closing the gap in health care for LGBTQ+ patients is paramount in addressing global health disparities and population care.

Evidence-Based Education on Care of LGBTQ Patients: Improving Knowledge and Attitudes Among Pediatric Nurses

BACKGROUND

Due to stigma and mistreatment, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients and their families often face barriers to accessing and receiving equitable health care. Pediatric settings are not immune to this health inequity, yet there is limited literature to address it with pediatric nurses.

METHOD

An evidence-based education program on the care of LGBTQ patients was delivered electronically to pediatric nurses. Using a pre- and posttest design, knowledge and attitudes regarding care of LGBTQ patients were collected via online questionnaires.

RESULTS

Knowledge significantly increased from pre- to posttest (p = .02). Attitudes related to LGBTQ concepts either remained consistently positive or shifted in the positive direction.

CONCLUSION

Providing education regarding LGBTQ patients to pediatric nurses can improve related knowledge and attitudes. Expansion of evidence-based LGBTQ education to pediatric nurses is likely to contribute to lessening the health care barriers and inequities faced by these patients and their families. [J Contin Educ Nurs. 2024;55(4):181-186.].

Intention to Use Different Formulations of Longer Acting HIV Pre-Exposure Prophylaxis Among Transgender and Gender Expansive Individuals: The Roles of Social Vulnerability and Medical Mistrust

In 2012, the Federal Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for HIV prevention in adults. Longer acting injectable PrEP (LA PrEP) has been approved and other formulations are in development. A successful LA PrEP rollout requires examining potential facilitators and barriers to PrEP uptake. Given that transgender and gender expansive (TGE) individuals experience more social vulnerability and higher levels of medical mistrust compared to other populations, examining the role of these two factors in LA PrEP uptake is important. This study, PrEP for ALL, is a community-based participatory research project in Texas that engaged TGE community members and organizational partners through a community advisory board. In total, 482 TGE individuals were recruited and responded to all relevant questions in an online survey, including their intentions to use three formulations: a monthly oral pill, a bimonthly intramuscular injection, and an annual subdermal implant. Multiple regression analysis was used to examine the influence of social vulnerability and medical mistrust on intention to use each LA PrEP formulation adjusting for other relevant factors. Findings suggest that individuals with higher levels of social vulnerability had greater intentions to use the monthly oral pill (β = 0.12, p = 0.009), the bimonthly intramuscular injection (β = 0.18, p < 0.001), and annual subdermal implant (β = 0.17, p < 0.001), whereas medical mistrust reduced intentions to use the bimonthly intramuscular injection (β = -0.18, p < 0.001) and annual subdermal implant (β = -0.11, p = 0.021). Improvements in gender-affirming clinical care are needed along with LA PrEP formulations that allow for greater autonomy and reduced clinical contact. Clinical Trial Registration number: NCT05044286.

Cultural humility among nursing students in a multicultural setting

BACKGROUND

Given the importance of cultural diversity in healthcare, the shift from "cultural competence" to "cultural humility" has become crucial. This transition is particularly relevant for nursing students in multiethnic regions, such as Southeastern Anatolia, Turkey, where diverse cultural interactions can significantly impact their professional development and practice.

OBJECTIVE

This study was conducted to determine the cultural humility levels of nursing students.

METHODS

This descriptive study was carried out with nursing students in two universities in the Southeastern Anatolia region, where the immigrant population is dense, in Turkey.

RESULTS

In this study, the total mean score of the Cultural Humility Scale of the students participating in the research was 70.03±16.01. A significant difference was found between the Cultural Humility scale mean scores of the students and their gender, nationality, native language, experience of going abroad, desire to live in another country, and enjoying spending time with people from different cultures (p < 0.05). Significant positive correlations were determined between the average scores provided by the students on a 0-10 scale, indicating the importance they placed on cultural diversity in nursing education, and both the total score of the Cultural Humility Scale and the mean score of its sub-dimensions (p < 0.01, r = 0.273).

CONCLUSION

This study found that the cultural humility level of nursing students living and studying with people from various cultures is sometimes exhibited.

Does discrimination prevent transgender and gender diverse people from seeking healthcare?: A nationwide cohort study in South Korea

Introduction

Using Asia's first nationwide cohort dataset, this study aimed to assess the prevalence of anti-transgender discrimination and healthcare avoidance and delay (HAD) and examine their associations among transgender and gender diverse (TGD) adults in South Korea.

Methods

We analyzed a two-wave (2020-2021) longitudinal dataset of 190 Korean TGD adults. Anti-transgender discrimination were classified accordingly: experienced at (1) neither wave, (2) baseline (2020) only, (3) follow-up (2021) only, and (4) both waves. We also asked about HAD in the past 12 months at follow-up for both transition-related and non-transition-related healthcare services. Multivariate modified Poisson regression was used to examine the associations between anti-transgender discrimination and HAD.

Results

Of 190 participants, 102 (53.7%) experienced anti-transgender discrimination at both waves, and 130 (68.4%) reported HAD at follow-up. Compared to those without any experiences of anti-transgender discrimination, those who experienced it in both waves had a 1.78-times (95% CI: 1.21-2.63) higher prevalence of non-transition-related HAD, but not among those who experienced it in either wave. In contrast, anti-transgender discrimination was not associated with transition-related HAD.

Conclusion

In order to enhance healthcare access for transgender and gender diverse (TGD) individuals, it is necessary to implement interventions, such as anti-discrimination laws, that protect them from discrimination.

Intersectional Examination of Gender-Inclusive Care and Women's Health

Transgender and gender-nonconforming people remain excluded from women's health spaces, and nurses with expertise in women's health best serve their needs when they seek sexual, reproductive, gynecologic, or obstetric care. However, commentary regarding the term "women" and exclusionary policies and behaviors in health care marginalize gender-nonconforming patients and contribute to health disparities. Therefore, the purpose of this article is twofold. First, we review terminology related to gender-nonconforming populations and their known health care needs; provide a brief historical overview of gender and health care; and describe the influence of White supremacist, misogynist, and heteronormative influences in women's health care. Second, we generate a call to action and specifically discuss the responsibilities of nurses and nursing organizations to ensure the provision of gender-equitable and respectful care and generate clinical recommendations for the specialty.

Perspectives From Community-Based HIV Service Organization Leaders on Priorities in Serving Sexual and Gender Minority Populations

Sexual and gender minority (SGM) populations experience discrimination and care-related barriers when seeking appropriate sexual health services. Using rapid assessment procedures we conducted site visits with 11 community-based HIV service agencies to identify priorities, assets, and needs related to serving SGM clients and assessed the alignment of these services with the city's local Ending the HIV Epidemic plan. We identified and mapped themes across agencies into the Consolidated Framework for Implementation Research domains of inner and outer settings: client-facing materials; priorities in serving SGM communities; SGM policies and protocols; collecting sexual orientation and gender identity data; training and education; and funding and scope of programs. Rapid assessment procedures can accelerate the collection and interpretation of data to help public health institutions and community partners make timely adaptations when implementing comprehensive and culturally humble sexual health services for SGM communities.

Implementing an LGBTQ+ interprofessional simulation with undergraduate nursing students

INTRODUCTION

Providing culturally competent care to members of the LGBTQ+ community is an essential role for nursing professionals. However, many healthcare professionals lack the knowledge and skills necessary for creating a therapeutic healthcare encounter with individuals from the LGBTQ+ community.

LITERATURE REVIEW

Individuals from the LGBTQ+ population continue to report experiencing either real or perceived discrimination, oppression, and stigmatization when accessing the healthcare system. Health professionals report a lack of training where LGBTQ+ individuals are concerned.

PURPOSE OF THE PROJECT

The purpose of this project was to (1) pilot one of the ACE+ scenarios and provide feedback to the NLN and (2) expand on the LGBTQ+ educational content in the curriculum.

DISCUSSION

Simulation-based learning activities are valuable and effective pedagogical tools for integrating essential LGBTQ+ care concepts into the curriculum. Students, faculty, and standardized participants perceived the simulated scenario as valuable. Recommendations for future implementations include utilizing a pool of trained standardized participants and ensuring ample pre-briefing, scenario facilitation, and debriefing time.

IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE

The insights from this project can be integrated into healthcare training programs worldwide to enhance care for LGBTQ+ individuals. Simulation offers a safe environment for practicing real-life scenarios, building skills, and assessing competencies to ensure nurses are prepared for professional practice across the globe.

CONCLUSIONS

Nursing programs should incorporate LGBTQ+ content into the undergraduate curriculum. Evidence-based simulation resources that are free and readily accessible can support nursing faculty in effectively incorporating these concepts.

Are funeral homes in the United States safe spaces for sexual and gender minorities? A website content analysis

LGBTQIA+ people, particularly those aging into end-of-life care decisions, need safety cues to identify safe spaces to access equitable death care. We conducted a website content analysis of 90 randomly selected funeral homes across the United States to evaluate the presence of LGBTQIA+ safety cues, such as inclusive language, symbols, imagery, and LGBTQIA+-friendly collaborations. Results showed that none of the selected funeral homes displayed any kind of safety cues. A significant change in funeral home marketing strategies is warranted so sexual and gender minorities can easily locate inclusive and affirming death care services.

Primary Healthcare Nurse’s Barriers and Facilitators to Providing Sexual and Reproductive Healthcare Services of LGBTQI Individuals: A Qualitative Study

In most cases, we only hear Lesbians, Gays, Bisexuals, Transgender, Queer, and Intersex (LGBTQI) patients complaining about nurses being the reason for not accessing and utilizing healthcare services; for example, studies reports on the different attitudes of healthcare providers including nurses against LGBTQI patients. However, factors influencing the behavior of South African Primary Healthcare (PHC) Nurses toward LGBTQI patients are rarely reported. The study aimed to explore how PHC nurses experienced and perceived sexual and reproductive health services for LGBTQI individuals in Tshwane, Gauteng Province, South Africa. The study followed qualitative research using an exploratory design approach. The sample included 27 PHC nurses from Tshwane, Gauteng Province, South Africa. In-depth face-to-face interviews were coded and analyzed using Thematic Content Analysis (TCA) which included five interrelated steps. The results revealed three main themes: barriers to the provision of LGBTQI-related SRHS, facilitators for the provision of SRHS to LGBTQI individuals, and strategies to improve LGBTQI individuals’ SRHS accessibility and availability. Common barriers were related to the institutions, PHC nurses, the general public, and LGBTQI patients themselves. Regardless of the challenges faced by PHC nurses, there were some enabling factors that pushed them to continue rendering SHRS to LGBTQI patients who came to their clinics. Almost all PHC nurses suggested the importance of awareness, transparency, collaboration, and the need for training related to LGBTQI healthcare issues.

Impact of Implementing Welcoming Clinic Space Indicators on Sexual and Gender Minority Patients' Health Care Experience

It has been well established that those identifying as a member of the sexual and gender minority (SGM) have difficulties accessing health care services. This is strongly associated with the desire to avoid discriminatory health care practices and prejudicial providers that many SGM individuals have encountered. Implementation of specific welcoming clinic space indicators (WCSIs) has been recommended to mitigate prior health care alienation experienced by SGM individuals. The project supported three HIV clinical care sites in Louisiana to implement and maintain identified SGM WCSIs as one of its interventions to improve sexually transmitted infection screening, testing, and treatment in people with and at-risk of HIV. This project found that SGM WCSIs had a positive impact on SGM individuals and were predominately unnoticed by those that were non-SGM-identifying individuals. Further, across the entire sample, the SGM WCSIs had an extremely low (<1%) level of negative impact, eliminating the misconception that SGW WCSI implementation may offend non-SGM individuals. There were differences in the implementation of the SGM WCSIs across the three sites associated with their governance structure and priority community. Implementation of SGM WCSIs should be considered as an important component of assuring culturally competent health care for SGM individuals.

Instituting Sexual Orientation and Gender Identity Training and Documentation to Increase Inclusivity at a Pediatric Health System

In this mixed-methods quality improvement project, we implemented and evaluated sexual orientation and gender identity (SOGI) form rollout in the electronic medical record. Families in our gender diversity program completed a baseline survey in 2017 (55/328 responded) and follow-up in 2020 (180/721 responded) to evaluate the frequency of affirmed name and pronoun use in the hospital. Survey feedback informed system-wide inclusivity efforts and training. SOGI was implemented in 2020 after 1,662 providers completed an online training and 11,090 team members completed gender and sexual orientation inclusivity training. We recommend similar trainings for health systems utilizing SOGI.

Achieving Health Equity for LGBTQ+ Adolescents

The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adolescent population experiences health disparities due to barriers to care, including lack of access to culturally competent health care providers. The purpose of this quality improvement project was to increase access to culturally competent care through continuing education, a physical makeover of clinic space, and a social marketing campaign. The impact of the project on the number of LGBTQ+ adolescent patients at the clinic and the rate of documentation of sexual orientation and gender identity data was evaluated via a chart audit. Changes in nurses' and health care providers' knowledge as a result of the continuing education were evaluated with a pretest and a posttest. The number of LGBTQ+ patients and provider knowledge increased following the continuing education. Sexual orientation and gender identity data were documented during 87.5% of visits. The participants' knowledge increased by 4.7% following the continuing education. Further, five physical changes to the clinic were completed and a social marketing campaign was launched. This quality improvement project demonstrates that continuing education can be an effective way to increase cultural competence for the care of LGBTQ+ individuals. [J Contin Educ Nurs. 2022;53(8):348-354.].

Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States

BACKGROUND

Sexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes.

AIM

The purpose of this study was to describe the characteristics of chronic pelvic pain experiences of young women by sexual orientation identity and gender of sexual partners.

METHODS

The analytical sample consisted of a nationwide sample of 6,150 U.S. young women (mean age = 23 years) from the Growing Up Today Study who completed cross-sectional questionnaires from 1996 to 2007.

OUTCOMES

Age-adjusted regression analyses were used to examine groups categorized by sexual orientation identity (completely heterosexual [ref.], mostly heterosexual, bisexual, lesbian) and gender of sexual partner (only men [ref.], no partners, both men, and women). We examined differences in lifetime and past-year chronic pelvic pain symptoms, diagnosis, treatment, and quality of life outcomes. Sensitivity analyses also examined the role of pelvic/gynecologic exam history and hormonal contraceptive use as potential effect modifiers.

RESULTS

Around half of all women reported ever experiencing chronic pelvic pain, among whom nearly 90% had past-year chronic pelvic pain. Compared to completely heterosexual women, there was greater risk of lifetime chronic pelvic pain among mostly heterosexual (risk ratio [RR] = 1.30, 95% confidence interval [CI]: 1.22-1.38), bisexual (RR = 1.30, 95% CI: 1.10-1.52), and lesbian (RR = 1.23, 95% CI: 1.00-1.52) young women. Additionally, compared to young women with only past male sexual partners, young women who had both men and women as past sexual partners were more likely to report chronic pelvic pain interfered with their social activities (b = 0.63, 95% CI: 0.25-1.02), work/school (b = 0.55, 95% CI: 0.17-0.93), and sex (b = 0.53, 95% CI: 0.05-1.00).

CLINICAL IMPLICATIONS

Healthcare providers, medical education, and field-wide standards of care should be attentive to the way sexual orientation-based healthcare disparities can manifest into differential prognosis and quality of life outcomes for women with chronic pelvic pain (particularly bisexual women).

STRENGTHS & LIMITATIONS

Our study is the first to examine a variety of chronic pelvic pain outcomes in a nationwide U.S. sample across different outcomes (ie, past-year and lifetime). Though limited by sample homogeneity in terms of age, race, ethnicity, and gender, findings from this article provide foundational insights about chronic pelvic pain experiences of sexual minority young women.

CONCLUSION

Our key finding is that sexual minority women were commonly affected by chronic pelvic pain, and bisexual women face pain-related quality of life disparities. Tabaac AR, Chwa C, Sutter ME, et al. Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States. J Sex Med 2022;19:1012-1023.

Working With Lesbian, Gay, Bisexual, and Transgender Clients: Occupational Therapy Practitioners' Knowledge, Skills, and Attitudes

IMPORTANCE

A lack of health care provider knowledge and training has been identified as one factor that contributes to health disparities for sexual and gender minority (SGM) populations.

OBJECTIVE

To explore occupational therapy practitioners' self-reported knowledge about, clinical preparedness for, and attitudes toward working with lesbian, gay, bisexual, and transgender (LGBT) clients.

DESIGN

Online survey of occupational therapy practitioners.

PARTICIPANTS AND SETTING

Respondents were recruited by means of snowball sampling through social media groups, state occupational therapy association websites, and emails. Surveys were posted to electronic occupational therapy social media sites.

MEASURES

Knowledge, clinical preparedness, and attitudes were measured using the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS). Information about demographic characteristics, education, and workplace was also collected.

RESULTS

Five hundred eighty-nine occupational therapy practitioners responded to the survey. Degree level (master's vs. bachelor's or less), continuing education (minimum 1-2 hr of LGBT-specific training), practice setting (mental health), minority sexual orientation, and having a close friend or family member who identifies as SGM were associated with higher mean scores on the LGBT-DOCSS. Higher religiosity and frequency of religious practice were associated with lower scores on knowledge and attitudinal awareness.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners often care for clients from backgrounds and cultures that differ from their own. Identifying gaps in education and opportunities for fostering LGBT-positive attitudes can facilitate the development of programs to improve practice with LGBT clients and help measure the effectiveness of such programs. What This Article Adds: This study provides evidence that a basic level of continuing education can improve occupational therapy practitioners' knowledge of and skills for working with LGBT populations and highlights the need to examine and change structural biases.

Promoting a gender-affirming environment in research: implications for research nurses

Background: Approximately 25 million people around the world identify as transgender, and the numbers are growing. While visibility of transgender communities has increased, significant healthcare disparities remain. Transgender individuals report being less inclined to share their sex assigned at birth due to fear of stigmatization and mistrust of the medical community. The mistrust and inequity experienced by transgender individuals are not limited to clinical care and may extend to clinical research as well. Aim and method: The aim of this paper is to start a conversation about barriers to participating in research and the role of research staff, specifically the Clinical Research Nurse, in promoting engagement of transgender individuals in clinical research trials. Discussion and conclusions: A discussion of safety considerations, data integrity, and implications for data management is included. Because disparities may result in large part from lack of education and knowledge on best practices for providing care for this population, recommendations for fostering a culture of competence and gender-affirming care among research professionals featuring the role of the research nurse will be discussed.

Moving Dietetics Forward with Queer Pedagogy: A Post-Structural Qualitative Study Exploring the Education and Training Experiences of Canadian Dietitians for LGBTQ Care

BACKGROUND

Lesbian, gay, bisexual, trans, and other sexually and gender diverse (LGBTQ) people often experience health disparities and disparities in accessing safe health care. Yet dietetic curriculum and training opportunities for LGBTQ care is limited.

OBJECTIVE

The objective of this research was to explore the perspectives and professional training experiences within LGBTQ-focused topics of Canadian dietitians in order to inform future curriculum and pedagogy.

DESIGN

This research is framed within poststructuralist philosophies. Semi-structured qualitative interviews were conducted.

PARTICIPANTS/SETTING

To be eligible, participants needed to be dietitians within Canada who had an interest in discussing gender and sexual diversity within the profession. Although the research call was open to all Canadian dietitians who wanted to discuss gender and sexual diversity within the profession, only dietitians who self-identified as allies to LGBTQ groups ended up participating in this project. Of the sixteen dietitians who participated, eleven participants self-identified as members of LGBTQ groups and five self-identified as straight. All participants took part in online interviews done in private locations of their choosing from September 2020 to January 2021.

ANALYSIS

A systematic thematic analysis was conducted.

RESULTS

Three themes, including 1) Understanding the ethics of dietetic education, 2) Recognizing the cis- and hetero-normativity of dietetic education, and 3) Moving forward with queer pedagogy, were noted from the data.

CONCLUSIONS

Participants explored the lack of LGBTQ focus and content during their professional training and believed such gaps were problematic to the caring philosophies of dietetics. Participants offered insights into how dietetic educators can disrupt ingrained cis- hetero-normativity and rigid binary gender norms within dietetics education and curriculum.

The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations

OBJECTIVE

Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection.

METHODS

Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI).

RESULTS

Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001).

CONCLUSION

Provider-patient communication may benefit sexual minority women's contraceptive practices and engagement with STI testing.

PRACTICE IMPLICATIONS

Differences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.

The Experiences of Transmasculine People with Contraception and Menstruation: A Literature Review of Qualitative and Mixed Method Studies

Purpose: A paucity of research exists concerning transmasculine experience with contraception and menstruation, despite these being possible sources of dysphoria. Understanding how transmasculine people navigate contraception and menstruation can help improve the quality of care provided for this community. This literature review consequently aims to synthesize the existing qualitative and mixed methodology literature on how transmasculine people experience and navigate contraception and menstruation. Methods: A systematically guided literature review was conducted on March 15, 2020, using CINAHL, EMBASE, Medline, PsychINFO, and Web of Science. Qualitative and mixed method studies written in English were included if (i) participants were transmasculine and older than 11 years, (ii) the research question focused on contraception and/or menstruation in the transmasculine community, and (iii) the study incorporated primary data. No publication time restrictions were placed. The analysis followed a meta-ethnographic approach, with the minority stress model and social norms theory used for guidance. Results: Five studies were found eligible for review, all published after 2015 and conducted in the United States. The majority of the total 360 participants were White and of a higher socioeconomic position. Three main thematic categories were present: (i) concerns with hormonal contraception use, including gender dysphoria and worries about interactions with testosterone; (ii) discrimination and fears around seeking health care, especially concerning the assumptions made by practitioners; and (iii) community as a positive influence, particularly for normalizing menstruation for transmasculine people. Conclusion: The data collected support the need for increased research concerning the interaction between hormonal contraception and testosterone. Reflection on assumptions, even ones made in an attempt to be supportive, can improve physician and transmasculine patient relationships. Finally, community normalization can be a powerful tool to decrease feelings of dysphoria around menstruation, and community voices should be included in all educational material concerning menstruation and contraception.

The Impact of Primary Care Providers' Bias on Depression Screening for Lesbian Women

Primary care providers' (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs' implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs' implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs (n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women (p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers' awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

Perceived difficulty of getting help to reduce or abstain from substances among sexual and gender minority men who have sex with men (SGMSM) and use methamphetamine during the early period of the COVID-19 pandemic

Background

This study examined the perceived difficulty of getting help with substance use among sexual and gender minorities who have sex with men (SGMSM) who use methamphetamine during the early COVID-19 period.

Methods

SGMSM, aged 18+, who reported sex with a man and methamphetamine use in the past 6 months were recruited to complete an online survey using online advertisements. Ordinal regression models examined predictors of greater perceived difficulty of getting help. Explanatory variables included participant characteristics (i.e., age, HIV status, ethnicity, sexuality, gender, region, income) and variables assessing patterns of methamphetamine use (i.e., frequency, % time methamphetamine is used alone and during sex; perceived need for help) and patterns of healthcare access (i.e., regular provider, past substance use service utilization).

Results

Of 376 participants, most were gay-identified (76.6%), white (72.3%), cisgender (93.6%), and had annual incomes of less than $60,000 CAD (68.9%). Greater perceived difficulty of getting help was associated with having lower income, sometimes using methamphetamine prior to or during sex, and greater perceived need for help.

Conclusion

Based on these results, we urge greater investments in one-stop, low-barrier, culturally-appropriate care for SGMSM who use methamphetamine. This is especially important given that participants who perceive themselves as needing help to reduce or abstain from substance use perceive the greatest difficulty of getting such help.

Sexual History Taking: An Opportunity to Reduce Health Disparities

ABSTRACT

Sexual history taking is an important part of caring for any clinical population. However, the topic is often wrapped in discomfort that makes it more challenging than it needs to be for both the provider and the individual providing the history. The act of taking an effective sexual history is more than simply asking all the right questions in the right ways; it requires an awareness of the impact of the clinical environment, the provider's own comfort with the content, and an awareness of any personal biases. In this study, we provide a framework for evaluating and addressing many of these factors as well as providing key points for consideration as a health care provider of any level. We offer several concrete strategies for including these strategies and processes in multiple clinical environments.

The integral role of nurses in primary care for transgender people: A qualitative descriptive study

AIM

To understand nursing activities, training and key supports needed to provide primary care to transgender individuals.

BACKGROUND

Discrimination, limited practitioner knowledge and a deficiency of services contribute to health care barriers for transgender individuals. Literature demonstrating how primary care services are delivered, and more specially the role of nurses in this care, is lacking.

METHODS

Qualitative description methodology and interviews were used to describe this phenomenon. Participants included nurse practitioners, registered nurses and registered practical nurses.

RESULTS

Nurses are important in providing primary care to transgender individuals. While NPs worked to full scope of practice, RNs' and RPNs' roles could be optimized. A key challenge was lack of education; however, mentorship and collaboration contributed to competency development. Ensuring the workplace provided gender-affirming care was key to a safe and inclusive environment.

CONCLUSIONS

Supporting nurses to develop capacity and work to full scope of practice can improve access to care. Ongoing opportunities for mentorship and ensuring an inclusive workplace will aid in the provision of care for this vulnerable population.

IMPLICATIONS FOR NURSING MANAGEMENT

Development of organisational policies, staff training and appropriate supports, for role optimization and team collaboration, can eliminate barriers experienced by transgender individuals.

How healthcare professionals can support older LGBTQ+ people living with dementia

Older lesbian, gay, bisexual, trans, queer and others (LGBTQ+) people living with dementia have specific needs related to their sexual orientation and identity that should be addressed to maintain their personhood. They may face challenges in health and social care settings, such as heteronormativity and lack of awareness of older LGBTQ+ needs. Service provision for older LGBTQ+ people with dementia is lacking. Healthcare professionals' attitudes towards older LGBTQ+ people with dementia are often poor and there is a clear need for better training, while increased knowledge and awareness would help to challenge the concept of heteronormativity. This article explores some of the needs of older LGBTQ+ people with dementia, the role of legislation and regulation and how healthcare professionals can provide support.