Primary Care Providers' Attitudes Related to LGBTQ People: A Narrative Literature Review

Gender-Diverse Patients' Awareness and Utilization of Gender-Affirming Laryngological Services

OBJECTIVE

Despite gender-affirming laryngological services (GALS; eg, voice therapy or surgery) being available nationwide, there is a discrepancy between the number of transgender and gender diverse (TGD) people with vocal incongruence and those who pursue services. Primary care is an important setting for accessing gender-affirming care, including learning about GALS. The purpose of this study was to understand the relationship between access to primary care and utilization of GALS.

METHODS

An anonymous cross-sectional online survey was developed in REDCap. Between June-November 2022, 187 TGD respondents answered all questions related to this analysis. We assessed the relationship between having a primary care provider (PCP) and use of GALS via logistic regression.

RESULTS

Of the 167 individuals who reported having a PCP, 54% reported familiarity with GALS, compared to 45% of individuals without a PCP. Compared to the group without a PCP, a greater proportion of individuals with a PCP had received professional voice therapy (21% vs 5%) and voice surgery (3% vs 0%). Logistic regression models did not demonstrate a significant effect of primary care access on either familiarity with, or use of, GALS.

CONCLUSION

Most respondents (89%) were linked to the medical community through a PCP. A greater proportion of respondents with a PCP had accessed professional voice therapy and voice surgery compared with respondents without a PCP, though this difference was not statistically significant. Increased communication between GALS providers and PCPs would raise awareness of available services and may strengthen the referral pipeline to increase access to vocal care.

LEVEL OF EVIDENCE

Level III.

A Call to Disrupt Heteronormativity and Cisnormativity in Physical Therapy: Perspectives of 2SLGBTQIPA+ Participants on Future Directions for PT Curricula

Purpose

To explore the perspectives of individuals with self-reported expertise and/or lived experiences regarding aspects of 2SLGBTQIPA+ health that should be included in pre-licensure physical therapy (PT) curricula across Canada, including how, when, and by whom this content should be delivered.

Method

We conducted a critical qualitative, cross-sectional study with semi-structured virtual interviews. We analyzed participants' perspectives thematically using the DEPICT method.

Results

Thirteen participants across Canada with a variety of gender identities and sexual orientations were interviewed. Participants described how transformative change on 2SLGBTQIPA+ issues in PT requires an approach that is based on interrupting heteronormativity and cisnormativity in PT curricula. Participants explained how this could be achieved by (1) emphasizing both historical inequities and present-day considerations for safe and inclusive practice, (2) introducing the content early and integrating it throughout the programme using a variety of large- and small-group sessions, and (3) including 2SLGBTQIPA+ individuals in content delivery and creation.

Conclusions

This study brings attention to the need for the PT profession to understand how the pervasive social structures of heteronormativity and cisnormativity shape education and practice, and offer strategies for disrupting complicity with these systems of inequality.

Improving the forensic genital examination for trans and gender diverse sexual assault complainants: three case reports

Trans and gender diverse people experience high rates of sexual violence and significant barriers to healthcare, including post-sexual assault healthcare. These barriers could lead to delays in presentations to sexual assault services and a reluctance to having forensic examinations, thereby impacting genital injury assessment and evidence collection. It is therefore important that clinicians working in sexual assault services understand how to best undertake forensic genital examinations, collect forensic genital specimens, and identify and document genital injuries in this population. This case report discusses three trans and gender diverse complainants of sexual assault seen at the Sexual Assault Resource Centre in Western Australia. These cases, along with an accompanying review of the literature, have been used to change the centre's practice towards this community to improve forensic genital examinations. This has included creating specific trans and gender diverse medical and forensic notes, improving clinician knowledge around trans and gender diverse genital examinations and genital injury profiles, creating an inclusive physical environment, improving trans and gender diverse patient knowledge around sexual assault services, and providing options for genital specimen collection.

Perceived attitudes toward LGBTQ + physicians among individuals with psychiatric illness in the religiously diverse Southern Region of Thailand: a multihospital-based survey

OBJECTIVES

This study purposed to analyze perceived attitudes toward LGBTQ + physicians and related factors among individuals with psychiatric illnesses in southern Thailand.

MATERIALS AND METHODS

From May to July 2023, a cross-sectional study was conducted at four psychiatric outpatient clinics in Southern Thailand. The questionnaires utilized were: 1) a demographic information questionnaire, 2) a questionnaire regarding attitudes toward LGBTQ + physicians, 3) a questionnaire evaluating individuals' attitudes toward LGBTQ + physicians while receiving medical attention, and 4) a patient-doctor relationship questionnaire. All data were analyzed using descriptive statistics, and the factors associated with perceived attitudes toward LGBTQ + physicians were analyzed using the Wilcoxon rank sum test, the Kruskal-Wallis test, and linear regressions. The analyses were conducted using the R Foundation for Statistical Computing software, version 4.3.1. Statistical significance was defined as a p-value of less than 0.05.

RESULTS

Among our 542 participants, the mean age was 36.3 ± 14.1 years. The majority were female (64.6%), Buddhist (62.4%), and diagnosed with depression (46.3%). Approximately three-quarters showed a good doctor-patient relationship (74.0%). The median (IQR) score of the perceived attitudes toward LGBTQ + physicians was 75 (66, 88). Predominantly, the LGBTQ + physicians were perceived as normal (76.3%) and being a viable part of society (88.7%). Moreover, our participants disagreed with the view that being an LGBTQ + physician was a sin (70.6%) or immoral (68.2%). They felt comfortable during history taking (79.0%), physical examination not involving private parts of the body (72.5%), and management for both medical (78.4%) and psychiatric conditions (81.4%) at the hands of LGBTQ + physicians. However, they reported feeling uncomfortable during history taking involving private matters (6.3%) and the physical examination of private parts (16.4%). Older age, absence of LGBTQ + close relatives/friends, and being a Muslim were associated with lower scores of perceived attitudes toward LGBTQ + physicians. Conversely, a higher level of education and a reported mismatch between the patient's sex and gender were associated with higher scores.

CONCLUSIONS

Most participants reported positive perceived attitudes toward LGBTQ + physicians. However, some age groups and adherents of Islam showed lower perceived attitude scores and reported feeling uncomfortable receiving medical treatment from LGBTQ + physicians. On the one hand, LGBTQ + physicians have cause to be concerned about this point; on the other hand, finding appropriate approaches to promote positive attitudes toward LGBTQ + physicians among these groups of people remains a necessity.

U.S. Pediatric Residents' Preparedness, Attitudes, and Knowledge in LGBTQ+ Health Care

INTRODUCTION

The objective of this study was to evaluate pediatric residents' lesbian, gay, bisexual, transgender, queer, and all sexual and gender diverse (LGBTQ+) care.

METHOD

In June 2022, U.S. pediatric residents completed an anonymous online survey including the Lesbian, Gay, Bisexual, and Transgender-Development of Clinical Skills Scale (LGBT-DOCSS).

RESULTS

Pediatric residents (n = 78) reported low-to-moderate annual amounts of LGBT curricular hours (3.32 ± 3.17) and LGBT patients (13.84 ± 15.11) as well as low-to-moderate clinical preparedness and knowledge and high positive attitudes. They were significantly less likely to report receiving adequate training and supervision, having experience, and feeling competent in transgender care compared with lesbian, gay, and bisexual care. In general, pediatric residents who reported more LGBT education and LGBT patients also reported higher LGBT-DOCSS scores.

DISCUSSION

Pediatric residents in this study had substantial shortcomings in LGBTQ+ care. Pediatric programs must increase LGBTQ+ education and LGBTQ+ patient exposure.

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.

Cultural Competence and Social Work: Sexual and Gender Diversity in Two Universities in the South of Europe

This study aims to analyze cultural competence through the knowledge and attitudes regarding LGBT people held by the students of social work at two universities in southern Spain (N = 512). An ex post facto correlational study has been conducted. The Sex Education and Knowledge about Homosexuality Questionnaire, the Modern Homonegativity Scale and the Negative Attitudes toward Transgender People Scale have been applied to gather information. Data analysis was carried out using frequencies, descriptive statistics, correlations and inferential statistics. The findings show that men, religious, and politically conservative people reported higher levels of homonegative and transphobic attitudes than women, non-religious and politically more liberal people. There is also a lack of specific knowledge on the reality of and specific legislation regarding LGBT people. There is a need to continue to examine and to progress in the training of future social workers in cultural competence, incorporating the contributions of feminist theory.

LGBTI + Persons' Experiences, Expectations, and Suggestions for Improving LGBTI + Healthcare Services in Turkey: A Qualitative Study

This study aimed to explore the experiences, expectations, and suggestions of LGBTI + persons from the health system in Turkey and their views on what kind of a health system they wish to have. Qualitative descriptive research was used as one of the qualitative research methods. Thirteen LGBTI + persons living in different provinces of Turkey were interviewed. While selecting the participants, the maximum diversity sampling method, one of the purposive sampling methods, was employed. Attention was paid to interview participants from different groups among LGBTI + persons (three gay men, five trans men, two trans women, one queer person, one lesbian person and one bisexual person). Thematic analysis was performed for the analysis of individual in-depth interviews. The expectations of the participants were grouped under three themes: (a) institutional functioning, (b) legal regulations, and (c) healthcare professionals. Each theme and 9 sub-themes demonstrate what kind of a health system LGBTI + persons want to have. Some of the common expectations of the participants are having LGBTI + friendly and free healthcare services, adoption of anti-discrimination laws, and receiving healthcare from professionals with LGBTI+-specific healthcare knowledge. Changes to be made by policy makers, hospital administrators and healthcare professionals in line with the results obtained from the research can improve the experiences of LGBTI + persons in terms of receiving a higher quality healthcare service.

Intersectionality: Understanding the Interdependent Systems of Discrimination and Disadvantage

The fight for gender equity in surgery extends well beyond the simplistic binary construct of man versus woman. Professor Kimberlé Crenshaw coined the term "intersectionality," which is used to describe the dynamic associations between the concepts of race, class, gender, and other individualized characteristics and their real-time interaction with one another in our society. Our review of intersectional identities among medical professionals attempts to examine the trends of difficulties at the intersections of an individual's identity within academic surgery, leadership in academic surgery, and the effects on patient outcomes in the United States. Specifically, we will focus on the interaction of race, ethnicity, religion, sexual orientation, family, disability, and international status. Much more research focused specifically on intersectional groups is required to statistically identify to what degree overlapping identities impact professional and patient care outcomes. Recognition of the problem and candid discussions will allow for vast improvements not only in surgical culture, but also in surgical care.

Perceived Discrimination in Health Care for LGBTQIA+ People Living With Parkinson's Disease

OBJECTIVES

People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, other non-cisgender, and non-heterosexual identities (LGBTQIA+) experience discrimination when accessing health care. We investigated specific experiences of LGBTQIA+ people with Parkinson's disease (PwP) as they are less known.

METHODS

Data were obtained from Fox Insight for PwP identifying as LGBTQIA+ (n = 210), cisgender, heterosexual women (n = 2,373) or cisgender, heterosexual men (n = 2,453). Discrimination in Medical Settings Scale responses and reports of whether gender identity or sexual orientation played a role in the perceived discrimination were compared across the groups.

RESULTS

Parkinson's diagnosis age was the youngest for LGBTQIA+ PwP. Despite similar levels of education with cisgender, heterosexual men, LGBTQIA+ people had lower levels of income and were more likely to be unemployed. Cisgender, heterosexual women and LGBTQIA+ PwP reported greater discrimination than cisgender, heterosexual men. Compared to cisgender, heterosexual men; LGBTQIA+ people (25%) and cisgender, heterosexual women (20%) were more likely to report their gender affected how they were treated; LGBTQIA+ PwP (19%) were more likely to report their sexual orientation affected how they were treated.

DISCUSSION

Women and LGBTQIA+ PwP may be at a higher risk for discrimination in medical settings. Facing disparities while receiving health care based on gender or sexual orientation can affect the health care utilization of PwP. Health care providers should consider their behaviors and interactions with PwP to ensure inclusive and welcoming health care environments.

Review of current 2SLGBTQIA+ inequities in the Canadian health care system

Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.

Early Exposure to Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) Medicine: Assessing Confidence and Comfort in Preclinical Medical Students

BACKGROUND

Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) individuals face unique health challenges when compared to the general population. Physicians can play an integral role in either addressing these health inequities or further perpetuate discrimination. Despite the growing LGBTQ+ population in the United States and exposure during clinical care, many medical schools still lack an effective, standardized LGBTQ+ healthcare curriculum. Research has shown that when medical students receive exposure to LGBTQ+ healthcare topics, it results in superior quality of care. Considering the unique challenges LGBTQ+ individuals face, coupled with the perception medical students have of the current LGBTQ+ curriculum, and the positive impact LGBTQ+ education may have on patient care, there is a need for an effective and standardized LGBTQ+ curriculum in medical school education.

OBJECTIVES

The aim of this study was to assess the effectiveness of a two-hour interactive LGBTQ+ workshop at increasing confidence and comfortability in LGBTQ+ topics and healthcare education for preclinical medical students.

METHODS

Twenty-five first- and second-year medical students participated in an optional two-hour interactive LGBTQ+ workshop. The first hour consisted of a lecture overviewing LGBTQ+ clinical medicine from a physician specializing in LGBTQ+ topics and care. The second hour was made up of four 15-minute stations. Students were split up evenly and rotated through these four stations consisting of: (1) a one-on-one standardized patient simulation, (2) discussion-based case scenarios, (3) an interactive seminar on transgender healthcare, and (4) a debriefing station. All facilitators and standardized patients were members of the LGBTQ+ community. Consenting participants were provided with a pre- and post-survey consisting of basic demographic questions, and 16 LGBTQ+ healthcare specific statements that they answered using a 7-point Likert scale.

RESULTS

Fifteen of the 25 (60%) preclinical medical students completed all components of both the pre- and post-survey. 53.3% of the respondents were heterosexual, while 40% identified as being a part of the LGBTQ+ community. Survey results demonstrated a significant increase compared to the pre-workshop baseline in preclinical student comfort and confidence in 12 out of the 16 LGBTQ+ healthcare specific statements after completion of the workshop.

CONCLUSIONS

Our study suggests that focused education, such as through workshops, on LGBTQ+ topics can significantly increase preclinical student comfort and confidence when encountering LGBTQ+ clinical scenarios. In the future, we hope this workshop is implemented within our core medical school curriculum as a mandatory course to reach a wider audience. This workshop offers an efficient and effective model for other medical schools to implement to educate their medical students on LGBTQ+ healthcare topics.

Experiences in the delivery of preconception and pregnancy care for LGBTIQA+ people: A systematic review and thematic synthesis of patient and healthcare provider perspectives

BACKGROUND

The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care.

AIM

The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement.

METHOD

Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research.

FINDINGS

A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.

Grounding Wellness: Coloniality, Placeism, Land, and a Critique of "Social" Determinants of Indigenous Mental Health in the Canadian Context

Authored by a small team of settler and Indigenous researchers, all of whom are deeply involved in scholarship and activism interrogating ongoing processes of coloniality in lands now known to many as Canada, this paper critically examines "social" and grounded determinants of Indigenous mental health and wellness. After placing ourselves on the grounds from which we write, we begin by providing an overview of the social determinants of health (SDOH), a conceptual framework with deep roots in colonial Canada. Though important in pushing against biomedical framings of Indigenous health and wellness, we argue that the SDOH framework nevertheless risks re-entrenching deeply colonial ways of thinking about and providing health services for Indigenous people: SDOH, we suggest, do not ultimately reckon with ecological, environmental, place-based, or geographic determinants of health in colonial states that continue to occupy stolen land. These theoretical interrogations of SDOH provide an entry point to, first, an overview of Indigenous ways of understanding mental wellness as tethered to ecology and physical geography, and second, a collection of narrative articulations from across British Columbia: these sets of knowledge offer clear and unequivocal evidence, in the form of Indigenous voices and perspectives, about the direct link between land, place, and mental wellness (or a lack thereof). We conclude with suggestions for future research, policy, and health practice actions that move beyond the current SDOH model of Indigenous health to account for and address the grounded, land-based, and ecologically self-determining nature of Indigenous mental health and wellness.

Health Center Leadership Perspectives Regarding Barriers to and Facilitators of Providing Culturally Responsive Care for Sexual and Gender Minority Patients

Purpose: This study identified barriers and facilitators associated with providing culturally responsive care for sexual and gender minority (SGM) patients at federally qualified health centers (FQHCs) in the United States, from the perspective of clinical leadership. Methods: Between July and December 2018, 23 semistructured, in-depth qualitative interviews were held with clinical leaders representing six FQHCs residing in rural and urban settings. Stakeholders included Chief Executive Officer, Executive Director, Chief Medical Officer, Medical Director, Clinic Site Director, and Nurse Manager positions. Interview transcripts were analyzed using inductive thematic analysis. Results: Barriers included personnel factors related to lack of training and fear, competing priorities, and environments that focused on treating all patients similarly. Facilitators included established partnerships with external organizations, staff with prior SGM training and knowledge, and active initiatives in clinic settings targeting SGM care. Conclusions: Clinical leadership expressed strong support for evolving their FQHCs into organizations that provide culturally responsive care for their SGM patients. FQHC staff across all levels of clinical care would benefit from regularly occurring training sessions on culturally responsive care for SGM patients. To ensure sustainability, improve staff buy-in, and mitigate the impact of staff turnover, improving culturally competent care for SGM patients should be a shared goal and responsibility for leadership, medical providers, and administrative staff. CTN Registration: NCT03554785.

Understanding eating disorder symptoms in same-gender couples: social environmental factors

BACKGROUND

Sexual minority individuals are at disproportionately greater risk for eating disorders, yet little is known about the ways in which factors in the social environment relate to eating disorder symptoms in this population. Utilizing an ecological systems theory framework, we investigated the relative relationships of macro level (i.e., internalization of sociocultural attitudes about appearance) and micro level (i.e., quality of romantic relationship) social environment influences.

METHODS

Men (n = 144) and women (n = 144) in committed same-gender relationships were recruited as a dyad and completed study questionnaires, including multiple measures of eating disorder symptoms. Multilevel models controlling for key variables (e.g., body mass index) were used to examine gender differences, main effects, and interactions.

RESULTS

Men reported greater internalization of sociocultural attitudes and uncontrolled eating. Greater internalization of sociocultural attitudes was related to greater eating pathology across all measures. For men, greater relationship quality was related to less uncontrolled eating.

CONCLUSIONS

Individuals in same-gender relationships experience macro (e.g., sociocultural) level vulnerability factors in relation to disordered eating; however, internalization of sociocultural attitudes may be greater for men. Support at the microsystem level in the form of a high quality committed romantic relationship appears to be helpful protection against uncontrolled eating for men.

"Ditch the white coats": What LGBTQ+ patients prefer in their primary care provider

BACKGROUND

Health disparities in lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) individuals are well documented, and there is a dearth of primary care providers (PCPs) with the knowledge, skills, and attitudes to sensitively care for this diverse population.

PURPOSE

The purpose of this research study was to ask LGBTQ+ patients what qualities they prefer in their PCP. The findings will be used to better prepare nurse practitioners (NPs) to care for this diverse community and inform the training of future NPs to provide patient-centered care to LGBTQ+ individuals.

METHODOLOGY

In this qualitative descriptive study, four focus groups were conducted remotely between December 2020 and January 2021 with self-identified LGBTQ+ patients of an LGBTQ+ health center in the northeast. Thematic analysis of the data elicited codes, categories, and themes. Strategies were implemented to promote trustworthiness of the results.

RESULTS

Twenty-eight participants shared the qualities they value in their PCP. Analysis revealed four themes: "Ditch the white coats"; "Meet me where I am"; "The relationship is key"; and "Be knowledgeable about and comfortable with LGBTQ+ people and their health care needs."

CONCLUSIONS

The focus groups elucidated important information on caring for the LGTBQ+ communities and insights into what NPs must do to provide patient-centered care to this diverse population.

IMPLICATIONS

These findings can improve practice through a better understanding of LGBTQ+ patients' perspectives. Additionally, this study demonstrates the feasibility of directly asking our patients what they want in their health care provider.

Factors associated with knowledge and vaccination intention for human papillomavirus on trans girls by their main caregiver: A cross-sectional study

Introduction

Trans women are highly affected by the human papillomavirus (HPV) and are at risk of suffering from HPV-related diseases such as oropharyngeal, anal, penile, or neovaginal neoplasia. HPV vaccination seems to be a good strategy to reduce HPV-related diseases, mainly during the early age before the first sexual intercourse, but only cisgender girls are covered by the National Health Services, while some high-risk groups such as trans girls are not included. Achieving a high vaccination rate is important in the adolescent population, but there are many factors that could affect it, such as lack of knowledge about HPV or fear of side effects by patients and main caregivers. The aim of our study is to analyze the knowledge of trans girls' main caregivers about HPV-related diseases in the general population and, in particular, in trans women, as well as factors associated with HPV vaccination intention.

Methods

A cross-sectional study was performed with the collaboration of main caregivers of adolescent trans girls, between 9 and 16 years old, assisted in two reference centers' multidisciplinary Gender Diversity Units. Information was requested through a self-completed questionnaire: HPV-related diseases Knowledge Transwomen questionnaire (HPV-TQ) was elaborated based on a 19-item self-administered questionnaire and score was standardized from 0 to 19 points. Percentage of correct answers was calculated and defined by the group of high scores that showed over 70% correct answers.

Results

A total of 65 main caregivers were included. Almost all main caregivers were mothers with a Caucasian ethnicity. The HPV-TQ average score was 11 (3.7) with an average correct answer of 58.1% (19.6). Only 17/65 (26.1%) of main caregivers were highly knowledgeable in HPV. Of 65 trans girls, 14 were already vaccinated (29.8% of trans girls over 12 years old); 78.5% were not vaccinated and only 21.5% had intentions to be vaccinated. The group with a high score in HPV-TQ had a longer follow-up at the transgender unit, a higher maternal vaccination rate, and a positive family history of HPV-related disease, especially in mothers.

Conclusion

Adolescent trans girls attended to in our units had a low rate and a low intention of vaccination against HPV. Education on and promotion and prevention of transgender HPV-related diseases should probably be implemented to achieve a higher knowledge and vaccination coverage in adolescent trans girls.

Assessing readiness factors for implementation of LGBTQ+ affirmative primary care initiatives: Practice implications from a mixed-method study

INTRODUCTION

Access and utilization barriers in primary care clinics contribute to health disparities that disproportionately affect lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. Implementing inclusive practice guidelines in these settings may decrease disparities. The purpose of this exploratory/developmental study is to identify key issues affecting the readiness of primary care clinics to implement such guidelines.

METHODS

Using a concurrent mixed-method research design, we conducted surveys, interviews, and focus groups with 36 primary care personnel in clinics in New Mexico, USA, to examine readiness to implement LGBTQ+ inclusive guidelines, analyzing factors affecting motivation, general organizational capacity, and innovation-specific capacity. We supplemented these data by documenting LGBTQ+ inclusive policies and practices at each clinic. We undertook descriptive analyses and between-subscale comparisons controlling for within-rater agreement of the survey data and iterative coding and thematic analysis of the qualitative data.

RESULTS

Quantitatively, participants reported significantly more openness toward adopting guidelines and attitudinal awareness for developing LGBTQ+ clinical skills than clinical preparedness, basic knowledge, and resources to facilitate implementation. Six themes derived from the qualitative findings corroborate and expand on these results: (1) treating all patients the same; (2) addressing diversity in and across LGBTQ+ populations; (3) clinic climates; (4) patient access concerns; (5) insufficient implementation support; and (6) leadership considerations.

CONCLUSION

This study demonstrates that personnel in primary care clinics support initiatives to enhance service environments, policies, and practices for LGBTQ+ patients. However, drawing on Iris Young's theory of structural injustice, we found that neutralizing discourses that construct all patients as the same and time/resource constraints may diminish motivation and capacity in busy, understaffed clinics serving a diverse clientele and reinforce inequities in primary care for LGBTQ+ people. Efforts are needed to build general and innovation-specific capacities for LGBTQ+ initiatives. Such efforts should leverage implementation teams, organizational assessments, education, leadership support, community engagement, and top-down incentives.

LGBTQ+ Affirming Care May Increase Awareness and Understanding of Undetectable = Untransmittable among Midlife and Older Gay and Bisexual Men in the US South

One of the most significant innovations in HIV prevention is the use of HIV treatment to prevent HIV transmission. This information has been disseminated as the "Undetectable = Untransmittable" (U = U) message. Despite evidence of effectiveness, U = U awareness, belief, and understanding remains limited in some communities. In this study, we examine whether having an LGBTQ affirming healthcare provider increases U = U awareness, belief, and understanding among midlife and older gay and bisexual men in the US south, an understudied and underserved population and region where new HIV infections are increasing. We used data from the Vanderbilt University Social Networks Aging and Policy Study (VUSNAPS) on sexual minority men aged 50 to 76 from four southern US states collected in 2020-2021. We found that only one in four men reported prior awareness of U = U, but awareness was higher among men who have an LGBTQ affirming provider. Among HIV negative men, those with an affirming provider were more likely to believe and understand U = U, have more accurate risk perception, and have ever tested for HIV. Improving access to LGBTQ affirming healthcare may improve U = U awareness, belief, and understanding, which could help to curb HIV transmission in the US south.

Assessing LGBTQ+ stigma among healthcare professionals: An application of the health stigma and discrimination framework in a qualitative, community-based participatory research study

This qualitative, community-based participatory research (CBPR) study examines the occurrence of LGBTQ+ stigma in healthcare guided by the Health Stigma and Discrimination Framework. We conducted focus groups with healthcare professionals, analyzed using a thematic analysis approach. Stigma drivers included knowledge deficits and transphobia. Facilitators were the binary organization of medical education and training, cisnormative system procedures, a lack of enforceable policy to reduce stigma, and workplace culture and norms. Stigma practices, such as prejudicial attitudes, gossip, and misgendering, primarily focused on transgender individuals. This study reinforces the need to reduce LGBTQ+ stigma in healthcare settings, with implications for multi-level interventions.

Measuring the attitudes of midwives toward sexual and gender minority clients: Results from a Cross-Sectional survey in Ontario

BACKGROUND

In Canada, Ontario midwives provide care to sexual and gender minority (SGM) people. Published literature shows how midwives' attitudes shape the experiences of lesbians, but research examining midwives' attitudes toward SGM people is lacking. Our study measured the attitudes of Ontario midwives toward SGM clients, hypothesizing that attitudes would be positive overall and that there would be no difference in attitudes across practice settings.

METHODS

Paper surveys (n = 926) with an option to respond online were sent to Ontario midwifery practices. We measured midwives' attitudes toward sexual minorities (11 questions, scores ranged from 11 to 55) and gender minorities (9 questions, scores ranged from 9 to 45), with higher scores indicating more positive attitudes. Overall and subgroup analyses were performed.

RESULTS

The 268 completed surveys indicated that midwives' attitudes were positive toward both sexual (mean score 49.2, maximum possible score of 55, ie, 89.4%) and gender minorities (mean score 38.9, maximum possible score of 45, ie, 86.4%). Analyses showed that attitudes toward SGM were associated with midwives' sexual identity and route of entry into the profession (ie, university-based vs bridging programs), but not practice setting.

CONCLUSIONS

Although attitudes of this subset of midwives toward SGM clients were positive, volunteer bias could account for this finding since 32.6% of respondents identified as sexual minorities. Since the attitudes of midwives who entered the profession through the university-based education program were significantly more positive than those who entered through international bridging programs, future research should examine how SGM-related content is integrated into midwifery education and training curricula.

Long-Acting Injectable ART and PrEP Among Women in Six Cities Across the United States: A Qualitative Analysis of Who Would Benefit the Most

Long-acting injectable (LAI) modalities have been developed for ART and PrEP. Women face unique barriers to LAI use yet little research has examined women's perceptions of potential LAI HIV therapy candidates. We conducted 89 in-depth interviews at six Women's Interagency HIV Study (WIHS) sites with women living with HIV (n = 59) and HIV-negative women (n = 30) from 2017 to 2018. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Participants identified specific sub-populations who could most benefit from LAI over daily pills: (1) young people; (2) women with childcare responsibilities; (3) people with adherence-related psychological distress; (4) individuals with multiple sex partners; and (5) people facing structural insecurities such as homelessness. Women are underserved by current HIV care options and their perspectives are imperative to ensure a successful scale-up of LAI PrEP and LAI ART that prioritizes equitable access and benefit for all individuals.

Development and psychometric properties of the tool for assessing LGBTQI+ health training (TALHT) in pre-licensure nursing curricula

BACKGROUND

There is a lack of comprehensive lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) content in pre-licensure nursing curricula. LGBTQI+ people commonly experience mistreatment from nurses and healthcare providers due to a lack of knowledge or personal biases. To date, few instruments exist to guide LGBTQI+-specific curricular improvement.

OBJECTIVES/DESIGN/SETTING/PARTICIPANT/METHODS

Johns Hopkins School of Nursing LGBTQI+ Health Initiative and Emory University School of Nursing developed the Tool for Assessing LGBTQI+ Health Training (TALHT) to assist in evaluating gaps and redundancies in LGBTQI+ health content within pre-licensure nursing curricula. Face and content validity were evaluated among experts in LGBTQI+ health, curricular development, nursing education, and measure development (N = 22). The TALHT was modified based on expert feedback and a pilot with pre-licensure faculty (N = 13) to evaluate utility and acceptability of the refined measure.

RESULTS

Face and content validity evaluation of the 60-item iteration of the TALHT showed that the majority of items were consistently relevant among external expert reviewers. However, the clarity and readability of items were lacking. We triangulated the quantitative and qualitative data from experts to adapt and reduce the number of items in the TALHT to 20 items. Pilot testing of the revised 20-item measure found that utility and acceptability of the tool were rated highly among pre-licensure faculty.

CONCLUSION

The validation of the TALHT comes at a time when this type of instrument is clearly needed. The Future of Nursing 2020-2030 report calls for nursing education to incorporate competencies in caring for diverse populations to promote health equity. The Essentials: Core Competencies for Professional Nursing Education calls for a transition to operationalization of competency-based nursing education. The TALHT provides faculty and programs with a valid and reliable means to operationalize implementation of those competencies as they pertain to LGBTQI+ health.

Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study

OBJECTIVES

Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan.

DESIGN

A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan.

METHODS

Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis.

RESULTS

Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding.

CONCLUSIONS

The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.

Out of the Closet: Nurse Practitioner Faculty Knowledge, Comfort and Willingness to Incorporate LGBTQ2SA Content into the Curriculum

BACKGROUND

To improve the health of LGBTQ2SA individuals, nurse practitioners need to increase their knowledge related to the health needs of sexual and gender minorities. However, nurse practitioners often feel unprepared as a result of a lack of content in their educational training. In order to better understand the current state of nurse practitioner education around sexual and gender minorities, it is critical to assess educational preparedness and faculty knowledge teaching the content.Purpose: The purpose of this study was to assess the knowledge and experience of nurse practitioner faculty in Ontario around LGBTQ2SA health and their comfort level teaching this material in the nurse practitioner program.

METHODS

This quantitative descriptive study used purposeful sampling to recruit faculty from the Ontario Primary Health Care Nurse Practitioner Program. Data was collected using a modified survey administered on the Opinio platform.

RESULTS

Twenty-three individuals completed the study. Most participants felt that LGBTQ2SA health content was important, but rarely or never taught. The most frequently identified strategies to promote faculty readiness to integration of LGBTQ2SA health topics into the curriculum included faculty development seminars, reviewing curriculum to identify gaps and partnering and utilizing LGBTQ2SA specific agencies as clinical sites.

CONCLUSIONS

Results indicate that barriers exist at the faculty level which may limit the extent to which LGBTQ2SA health topics are incorporated into the curriculum. Supporting faculty to develop their knowledge and comfort with this topic will allow them to better educate students to care for LGBTQ2SA clients.

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.

“Here in the Bible Belt, It’s Predominantly Negative”: Sexual Identity Stigma in the American South, 50 Years After Stonewall

Lesbian, gay, bisexual, and pansexual (LGB+) individuals have disproportionate rates of mental illness. Minority stress and sexual identity stigma are posited as the primary social determinants of LGB+ mental health disparities. Discussions in the literature have questioned the impact of sexual identity stigma in a world increasingly accepting of sexual minorities. Additionally, the LGB+ population in the United States South is often overlooked in American research. This article details a qualitative study exploring experiences related to sexual identity stigma among adults who identify as LGB+ in the United States South. Semi-structured interviews with 16 individuals were analyzed using content analysis. Six thematic categories of stigma emerged from participants’ experiences: (a) navigating an LGB+ identity, (b) social acceptability of an LGB+ identity, (c) expectation of LGB+ stigma, (d) interpersonal discrimination and harassment, (e) structural stigma, and (f) relationship with the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Findings suggest that sexual identity stigma remains a common experience among these Southern United States participants. Further, thematic categories and subcategories primarily aligned with extant theory with one exception: Intracommunity stigma, a form of stigma emanating from the LGBTQ community, emerged as a stigma type not currently accounted for in theoretical foundations underpinning mental health disparities in this population.

Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers

Background

The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model.

Objective

In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health—a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform—was created.

Methods

The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States.

Results

The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics.

Conclusions

A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population.

A Nationwide Survey of COVID-19 Testing in LGBTQ+ Populations in the United States

OBJECTIVES

Lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) people and populations face myriad health disparities that are likely to be evident during the COVID-19 pandemic. The objectives of our study were to describe patterns of COVID-19 testing among LGBTQ+ people and to differentiate rates of COVID-19 testing and test results by sociodemographic characteristics.

METHODS

Participants residing in the United States and US territories (N = 1090) aged ≥18 completed an internet-based survey from May through July 2020 that assessed COVID-19 testing and test results and sociodemographic characteristics, including sexual orientation and gender identity (SOGI). We analyzed data on receipt and results of polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2 and symptoms of COVID-19 in relation to sociodemographic characteristics.

RESULTS

Of the 1090 participants, 182 (16.7%) received a PCR test; of these, 16 (8.8%) had a positive test result. Of the 124 (11.4%) who received an antibody test, 45 (36.3%) had antibodies. Rates of PCR testing were higher among participants who were non-US-born (25.4%) versus US-born (16.3%) and employed full-time or part-time (18.5%) versus unemployed (10.8%). Antibody testing rates were higher among gay cisgender men (17.2%) versus other SOGI groups, non-US-born (25.4%) versus US-born participants, employed (12.6%) versus unemployed participants, and participants residing in the Northeast (20.0%) versus other regions. Among SOGI groups with sufficient cell sizes (n > 10), positive PCR results were highest among cisgender gay men (16.1%).

CONCLUSIONS

The differential patterns of testing and positivity, particularly among gay men in our sample, confirm the need to create COVID-19 public health messaging and programming that attend to the LGBTQ+ population.

Clinician's Experience and Self-Perceived Knowledge and Attitudes toward LGBTQ + Health Topics

Phenomenon: Research on clinicians' knowledge and attitudes toward lesbian, gay, bisexual, transgender, queer/questioning, and other sexual and gender minorities (LGBTQ+) health topics has relied mostly on small early-career samples. The influence of clinical experience on knowledge and attitudes has not been examined. The study purpose was to examine physicians' and advanced practice providers' (a) self-perceived knowledge and attitudes about LGBTQ + health topics, (b) the relationship between clinical experience and self-perceived knowledge and attitudes, and (c) preferences for LGBTQ + medical education.Approach: An online anonymous survey was emailed to 3667 physicians and advanced practice providers at a large southeastern multisite healthcare institution. Logistic regression determined associations between clinical experience, knowledge, and attitudes.Findings: There were 880 (24.0%) respondents. Most were physicians (70%). Thirty-eight percent had more than 15 years of experience. Fifty-four percent preferred online education. Few reported sophisticated knowledge of six LGBTQ + health topics (6%-10%). The majority felt that these were either important or very important for all physicians. After accounting for demographics, experience was not associated with knowledge or attitudes.Insights: Knowledge gaps yet positive attitudes suggest that additional training on LGBTQ + patients is warranted and likely to be well received. The lack of influence of experience on knowledge and attitudes may suggest that training is applicable to clinicians of all experience levels. Future research should determine if knowledge and attitudes toward LGBTQ + health topics influence culturally competent healthcare practices.

A National Study of Medical Students' Attitudes Toward Sexual and Gender Minority Populations: Evaluating the Effects of Demographics and Training

Purpose: Evaluating medical students' attitudes toward sexual and gender minority (SGM) people is important to identify negative attitudes early in education and to design curriculum to mitigate biases. The purpose of this study was to investigate medical students' attitudes toward SGM people as a whole as well as specific populations within the SGM community. We sought to determine whether attitudes toward SGM people differed between students' demographics and training. Methods: We conducted an online survey-based study among 1007 medical students at 12 U.S. medical schools. Participants completed the Attitudes Toward LGBT People Scale and were randomized to complete another scale specific to one group within the SGM community. We evaluated the association between student demographics and medical training and attitudes toward SGM people overall and toward specific SGM populations. This study was conducted between January and June 2020. Results: Overall, we found that medical students had positive attitudes toward SGM people and specific SGM groups. The most important factor affecting medical students' attitudes on all scales was religiosity, as very religious students held less positive attitudes toward SGM people. In addition, cisgender female students held more positive attitudes toward SGM people overall and toward specific SGM populations. Conclusion: Medical education must ensure that future physicians receive comprehensive and culturally competent training to prepare them to care for SGM patients. Based on our findings, this training should include specific content to help medical students identify potential biases toward SGM people, as well as strategies to acknowledge and confront these biases.

Providing Care to LGBT Patients in Guyana: An Assessment of Medical Providers' Knowledge, Attitudes and Readiness to Learn

This study investigated the knowledge, attitudes and desire for continued education among Guyanese doctors with regards to LGBT health. It utilized a mixed methodology of quantitative, self-administered online surveys among 90 doctors, and qualitative semi-structured individual interviews with 8 other doctors. Descriptive and analytic calculations were performed on the quantitative data while thematic analysis was used for the qualitative data. The results show moderate knowledge levels regarding LGBT health, with deficits in awareness of LGBT health disparities; generally nondiscriminatory attitudes; and suboptimal education on LGBT health. Further training and pre-service curricular changes are necessary to address gaps and improve competency.

Training healthcare professionals in LGBTI cultural competencies: Exploratory findings from the Health4LGBTI pilot project

OBJECTIVES

Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience health inequalities and barriers to accessing healthcare at a greater rate than the general population. This paper aims to present the Health4LGBTI training course for healthcare workers and the results of its pilot implementation.

METHODS

Funded by the European Parliament, the training course was developed by a multidisciplinary team including LGBTI organisations as part of the Health4LGBTI Project. 110 healthcare professionals from diverse medical fields attended the pilot training in six European Member States. Knowledge and attitudes were compared on the basis of a pre-post evaluation design utilising an ad hoc questionnaire.

RESULTS

Knowledge scores increased after the training, irrespective of age and sexual orientation of participants. Attitudes scores generally improved, particularly in terms of inclusivity and a greater acknowledgement of LGBTI health needs and self-competence.

CONCLUSION

The Health4LGBTI training course is both feasible and effective in training healthcare professionals and support staff to improve cultural competence and thereby promoting inclusive healthcare practice.

PRACTICE IMPLICATIONS

The Health4LGBTI training course can be implemented in different healthcare contexts. Piloting of the course provided an opportunity for healthcare professionals and for support staff to improve their knowledge of, and attitudes towards, LGBTI people.

Physicians and healthcare professionals in the era of #Metoo

Gender Based Violence is and has been a pervasive problem in our societies and communities. In recent times, there has been a renewed emphasis on the problem given the #MeToo movement and social activism. In this editorial, we discuss healthcare professions and gender-based violence in light of the #MeToo movement. Also, three major types of exchanges in the healthcare field have been described in relation to gender-based violence. Implications for practice and prevention of gender-based violence in healthcare systems worldwide have been discussed. Healthcare industry is one of the biggest and most prominent enterprises worldwide with lives at stake. Safety of providers and patients and violence free healthcare workplaces can significantly improve health outcomes. The #MeToo movement reminds us of our responsibilities and professional codes of conduct and demands that we always keep at the forefront—the rights of those we serve or interact with.