Associations Between Trauma-Informed Care Components and Multiple Health and Psychosocial Risks Among LGBTQ Survivors of Intimate Partner Violence

Characterizing patient care experience among adults with lower extremity trauma

BACKGROUND

The subjective experience of receiving surgical care is an important aspect of health care delivery. We aimed to characterize the care experience following traumatic lower extremity injury using patient-reported experience measures validated for this population.

METHODS

In this cross-sectional study, patients with lower extremity trauma completed the LIMB-Q Satisfaction with Decision, Satisfaction with Information, and Satisfaction with Health Care Professional scales (scored 0-100, greater is better). We collected demographic, clinical, and patient-reported outcome data. Multivariable linear regression was used to identify independent predictors of LIMB-Q scores.

RESULTS

We collected data from 645 patients. Their mean age was 42 years (SD 17 years), and 62% were cisgender men. Patients reported high satisfaction with their surgeon (Mean=91 [SD 14]) but less satisfaction with how decisions were made regarding their care (Mean=74 [SD 26]) and the information they received about their care (Mean=70 [SD 21]). Each decade after injury was associated with a mean 4.8-point reduction in Satisfaction with Decision score (95% CI -0.74,-0.22). Education level was inversely associated with Satisfaction with Information (p=0.03). Compared to cisgender men, transgender and nonbinary patients reported less satisfaction with treatment decisions (mean difference [MD]=-27; 95% CI -46,-7.5) and health care professionals (MD=-30; 95% CI -55,-5.1). Compared to White patients, Asian or Pacific Islander patients reported lower satisfaction with health care professionals (MD=-19; 95% CI -36,-1.8) and treatment decisions (MD=-17; 95% CI -29,-3.7).

CONCLUSIONS

Patients with lower extremity trauma reported high levels of satisfaction with surgeons, but less satisfaction with treatment decisions and information. Satisfaction varied with demographic factors.

REPRODUCTIVE HEALTH IN TRANS AND GENDER-DIVERSE PATIENTS: Trauma-informed reproductive care for transgender and nonbinary people

In brief

There are some unique aspects to providing trauma-informed reproductive care to transgender and nonbinary people, who are affected by minority stress, stigma, and particular forms of trauma; we review the evidence and suggest strategies for the provision of trauma-informed reproductive care to gender minorities.

Abstract

Stigma and minority stress affect the health of transgender and nonbinary (TGNB) people, leading to disparities across a range of outcomes. Barriers to accessing care, including reproductive care, further complicate these health disparities. Interpersonal stigma within the healthcare system, and high rates of physical and sexual violence survivorship, make TGNB people particularly vulnerable to healthcare trauma and poor care. This is particularly true among TGNB people with multiple intersecting marginalized identities. Trauma-informed care provides a framework for medical practitioners to provide safe, holistic, and sensitive care. Scant academic literature discusses trauma-informed reproductive care for TGNB individuals. We present a narrative review of the evidence for trauma-informed reproductive care for TGNB people and suggest potential application and implementation.

Negative Sexual Experiences Among Gay, Bisexual, and Other Men Who Have Sex with Men Using GPS-Enabled Hook-Up Apps and Websites

Gay, bisexual, and other men who have sex with men (GBMSM) often use GPS-enabled dating apps and websites to facilitate in-person sexual encounters. Many of these encounters are positive and enjoyable. However, there is limited research on GBMSM's negative experiences with partners from hookup and dating apps/websites, especially those characterized by threats to GBMSM's sexual, physical, and/or psychological safety. In this report, we investigated this matter. We analyzed data from interviews with GBMSM (N = 60) and identified four categories of negative sexual experiences, each of which were comprised by sub-categories: 1) sexual violence (physical sexual assault, verbal sexual coercion, intoxicated assault/coercion), 2) sexual health risk behaviors (condom use resistance and coercion, deception related to HIV/STI status), 3) non-negotiated behaviors (undiscussed/unexpected sex acts, rough sex, sexualized racism, undesired substance use by the partner), and 4) threats to physical safety beyond sexual violence (being blocked from leaving, stalked, robbed, drugged). These results can inform future research and interventions that aim to promote safety on dating apps/websites within the GBMSM community.

Healthcare experiences of LGBTQ+ people: non-binary people remain unaffirmed

Introduction

Lesbian, gay, bisexual, transgender, queer, and all sexually and gender diverse (LGBTQ+) people experience discrimination across many contexts, including healthcare environments. While some research has shown transgender people and non-binary people often endure higher rates of marginalization than cisgender, sexually diverse people, past data are limited.

Methods

A sample of LGBTQ+ people (N = 173) in the United States completed an anonymous, online, self-reported survey, which included the Consumer Assessment of Healthcare Providers and Systems and healthcare experience questions. Groups, including people who identified as cisgender, sexually diverse (n = 116), transgender (n = 24), and non-binary (n = 33), were compared using chi-square and multivariate analysis of covariance tests.

Results

Compared to cisgender, sexually diverse people, non-binary people were less likely to report feeling comfortable with a physical exam, having good mental health, respected by providers, that providers had adequate medical information, that providers could care for someone going through gender affirmation, and that hospital staff were comfortable interacting with them. Additionally, non-binary people were more likely to report hospital staff misgendering them.

Discussion

These unique LGBTQ+ subgroup differences may be secondary to identity-specific stigma that non-binary people face. More international studies are needed to elucidate these subgroup-specific healthcare experiences across LGBTQ+ identities.

Preliminary Pilot-Testing of Intimate Partner Violence Screening for Transgender and Gender Diverse (TGD) Individuals in Med-Peds and Family Medicine

INTRODUCTION

Transgender and gender diverse (TGD) individuals, comprised of those whose gender identity does not correspond with the sex they were assigned at birth, represent approximately 1.4 million people in the U.S., with a higher prevalence among those 18-24 years old. TGD individuals experience high levels of intimate partner violence (IPV), which leads to disproportionately negative mental and physical health outcomes for this population. As a result, there is a resounding need to connect TGD populations to health-promoting services, supports and resources. Med-Peds and Family Medicine clinics may be particularly well-positioned to support these efforts due to physicians' focus on transitional-aged youth and young adults under 30.

METHODS

The current manuscript reports on processes and outcomes related to a quality improvement (QI) initiative that aimed to test the feasibility and acceptability of implementing IPV screening within both a Med-Peds and a Family Medicine specialty clinic serving TGD populations in Los Angeles, CA. This QI initiative included screeners that capture IPV in cisgender/non-TGD populations (Humiliation, Afraid, Rape, Kick [HARK]) as well as in TGD populations specifically (IPV-T). We utilized a mixed-methods approach to both quantify and qualify responses to existing IPV screening as well as informal feedback from clinic "champions" in each clinic.

RESULTS

Quantitative and qualitative findings from this QI initiative, featuring both general and TGD-specific IPV screening measures with 140 TGD individuals, elucidated several important processes that can support effective IPV screening and referral to supports and services. These include the importance of interdisciplinary teams, the utility of an iterative approach to screener roll-out, and the essential role of solidifying a referral process in these efforts. This project additionally shed light on the potential utility and challenges of implementing both general and TGD-specific IPV screening measures. Our pilot test did not support the necessity of a TGD-specific IPV screener for identifying and responding to IPV in this population, yet additional data is critical to generate more conclusive recommendations.

CONCLUSION

We recommend larger-scale data collection efforts to evaluate the utility of integrating general and TGD-specific screeners into clinic workflows to ensure optimal health promotion for the TGD population in Med-Peds and Family Medicine clinics.

Exploring the Mental Health Challenges and Coping Behaviour of Lesbian, Gay, and Bisexual Students at an Institution of Higher Learning

The South African university community is predominantly heterosexual, which fosters stigmatisation and discrimination against LGBTQI students despite the efforts to create conditions where LGBTQI students can succeed academically, socially, and personally. The study aimed to explore and describe the challenges experienced by LGBTQI students and their mental well-being as well as the coping behaviours adopted in a university in South Africa. This was accomplished using a descriptive phenomenological approach. A snowballing sampling method was used to select ten students who identified themselves as gay, lesbian, and bisexual (LGB). Semi-structured one-on-one interviews were conducted, and data were analysed thematically. The students perceived character defects stigma from fellow students and lecturers in and out of class. The mental health challenges experienced included a diminished sense of safety, lack of a sense of belonging, low self-esteem, and acting out of character. As a result, confrontation, passive withdrawal, and active dependent behaviour were utilised as different types of coping behaviour. The LGB students were subjected to stigma that negatively affected their mental health. Therefore, creating awareness about the rights of LGBTQI students to education, safety, and self-determination is recommended.

Gender-affirming Care for Transgender Patients

Lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, plus (LGBTQIA+ or LGBTQ+) individuals face a wide array of health disparities both within and separate from the healthcare system. Transgender patients are subject to microaggressions, misgendering, and harassment from providers, medical staff, and fellow patients. These patients experience drastic disparities in suicidality, depression, anxiety, substance use, malignancy, sexually transmitted disease (STD), and victimization of violence. Providers have the opportunity to intervene and positively impact patient experiences through gender-affirming care, but they first require an adequate knowledge base and understanding of the importance of sensitive and inclusive care. Seemingly small interventions, such as listing one's own pronouns, using gender-neutral language, validating and affirming patients, and utilizing appropriate mental and physical health screenings, can lead to significant impacts on the patient experience, health outcomes, and quality of life. This article will discuss some of the most common disparities and obstacles faced by transgender patients and will argue the paramount role of the provider in establishing gender-affirming care and some high-impact avenues which the provider, regardless of specialty, may pursue when caring for these patients.