1
|
Burton CH, van Zuilen MH, Primbas A, Young ME, Swartz K, Colburn J, Kumar C, Klomhaus A, Chippendale R, Streed CG. Sexual and gender minority health-related content in geriatric fellowships. J Am Geriatr Soc 2024; 72:866-874. [PMID: 37710405 DOI: 10.1111/jgs.18563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/25/2023] [Accepted: 07/01/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Despite a growing number of older lesbian, gay, bisexual transgender, and queer (LGBTQ) adults in the United States, education on care for this vulnerable population has historically been inadequate across all levels of training. This research assessed the extent of LGBTQ education in geriatric medicine fellowship curricula across the United States. METHODS We designed a survey to anonymously collect information from geriatric medicine fellowship programs on LGBTQ curricular content. Eligible participants included all 160 fellowship directors on record with the American Geriatrics Society. The survey addressed demographics of the fellowship program, current state of inclusion of LGBTQ content in didactic curricula and in clinical settings, and other available training opportunities. RESULTS Out of those contacted, 80 (50%) completed the survey. Of the programs surveyed, 60 (75%) were housed in internal medicine, 19 (24%) were in family medicine, and one was in their own department. Forty-seven fellowships (59%) reported some formal didactic session (e.g., lecture or case based), with the majority of these programs (72%) featuring 1-2 h of formal instruction. Forty-five programs (56%) reported offering no formal clinical experiences. There was less than 50% coverage for all surveyed topics in the required curriculum (range 46% for discrimination to 9% for gender affirming care). Time and lack of expertise were cited as the main barriers to content inclusion. CONCLUSIONS Curricular content regarding care for LGBTQ older adults is inadequate in geriatric medicine fellowships. Faculty development of current educators and providing standardized guidelines and curricula are steps toward addressing this deficit.
Collapse
Affiliation(s)
- Carl Henry Burton
- Division of Geriatrics, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Maria H van Zuilen
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami VA Healthcare System, GRECC, Miami, Florida, USA
| | - Angela Primbas
- Division of Geriatrics, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Megan E Young
- Section of Geriatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kristine Swartz
- Department of Family and Community Medicine, Division of Geriatrics and Palliative Care Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jessica Colburn
- Division of Geriatric Medicine & Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chandrika Kumar
- Division of Geriatric Medicine & Gerontology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine UCLA, Los Angeles, California, USA
| | - Ryan Chippendale
- Section of Geriatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Carl G Streed
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Fitzpatrick PJ, Keeley H. Determining staff experience of lesbian, gay, bisexual and gender identity presentations in child and adolescent mental health settings. Ir J Psychol Med 2024; 41:161-162. [PMID: 36239251 DOI: 10.1017/ipm.2022.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | - Helen Keeley
- Health Service Executive, Child and Adolescent Mental Health Services, Cork, Ireland
| |
Collapse
|
3
|
Salter RO, Barham L, Young DL, McIntosh C, Butler CJ. Integrating lesbian, gay, bisexual, transgender, and queer (LGBTQ) competency into the dental school curriculum. J Dent Educ 2024. [PMID: 38396361 DOI: 10.1002/jdd.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/21/2023] [Accepted: 01/13/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Decreasing healthcare disparities in marginalized communities requires healthcare providers who understand and appreciate social, economic, and cultural backgrounds. This includes care and education focused on individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). METHODS This study examined dental students' and residents' self-reported clinical preparedness, prejudicial attitudes (implicit and explicit), and knowledge of health disparities that exist in the LGBTQ community using the Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Scale (LGBT-DOCSS) prior to and after the presentation of an LGBTQ competency course. RESULTS A total of 178 dental students at a private US dental school ranging from D1 to first-year postdoctoral residency participated in the course and completed both pre-course survey and post-course survey. Sixty-seven percent of the students reported having formal training in LGBTQ competency prior to completing the pre-training survey. The results of the LGBT-DOCSS in this population following intervention training revealed an increased feeling of clinical preparedness in treating LGBTQ patients, decreased bias toward LGBTQ, and increased knowledge of health disparities in the LGBTQ community. A more significant percentage of male respondents self-reported prejudicial beliefs. Knowledge of LGBTQ health issues increased significantly among pre-clinical students. CONCLUSION Introducing an early intervention LGBTQ competency course in the dental curriculum is an effective method of improving students' awareness and self-confidence in working with LGBTQ patients while decreasing biases that may have existed prior to a training course.
Collapse
Affiliation(s)
- Reginald O Salter
- Department of Comprehensive Care, Howard University, Washington, District of Columbia, USA
| | - LaToya Barham
- Department of Pediatric Dentistry, Howard University, Washington, District of Columbia, USA
| | - Daniel L Young
- Department of Pediatric Dentistry, Howard University, Washington, District of Columbia, USA
| | - Crystal McIntosh
- Department of Periodontics, Howard University, Washington, District of Columbia, USA
| | - Craig J Butler
- Department of Prosthodontics, Howard University, Washington, District of Columbia, USA
| |
Collapse
|
4
|
Schafer T, Schnarrs PW, Baldwin A. Two Gender Medicine: Provider-Side Barriers to Caring for Transgender and Gender Diverse Patients. JOURNAL OF HOMOSEXUALITY 2024:1-23. [PMID: 38319650 DOI: 10.1080/00918369.2024.2314030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Experienced and anticipated discrimination during health care visits result in lower health care utilization rates, which contribute to persistent health disparities between transgender and gender diverse (TGD) individuals and the general population. Most strategies for improving health care delivery to TGD patients place the responsibility on providers, overlooking the role of medical systems and institutions in creating the environments where negative health care experiences occur. Relying on the inhabited institutionalism framework, this study explores system- and institutional-level barriers to the provision of quality care to TGD patients identified by health care providers and administrators, including relevant contextual details of, and interactions between, these barriers. Based on interview data from health care providers and administrators from a variety of practices across Texas, we identified two overarching themes and six subthemes. We demonstrate how our interviewees' responses reveal an institutional logic of "two-gender medicine," which creates barriers to health care provision in both formal medical education and training and throughout the managed care model of practice. We also illustrate how health care workers find ways to resist this logic in the course of their practice. Addressing these barriers to delivering competent and compassionate care to TGD patients that providers encounter could make long overdue strides toward addressing health disparities.
Collapse
Affiliation(s)
- Tyler Schafer
- Department of Sociology, California State University Stanislaus, Turlock, California, USA
| | - Phillip W Schnarrs
- Department of Population Health, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Aleta Baldwin
- Department of Public Health, California State University Sacramento, Sacramento, California, USA
| |
Collapse
|
5
|
Harvey TD. "We're Here, We're Queer, Get Used to It": Advancing LGBTQ +-Inclusive Language in Public Health. Am J Public Health 2024; 114:170-172. [PMID: 38335477 PMCID: PMC10862209 DOI: 10.2105/ajph.2023.307529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Tyler D Harvey
- Tyler D. Harvey is with the Yale School of Medicine, New Haven, CT
| |
Collapse
|
6
|
Fitzgerald B, Terndrup C, Streed CG, Lee RS, Patel VV, Nall R. The Society of General Internal Medicine's Recommendations to Improve LGBTQ + Health. J Gen Intern Med 2024; 39:323-330. [PMID: 37803097 PMCID: PMC10853142 DOI: 10.1007/s11606-023-08400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/24/2023] [Indexed: 10/08/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ +) individuals experience bias in healthcare with 1 in 6 LGBTQ + adults avoiding healthcare due to anticipated discrimination and overall report poorer health status compared to heterosexual and cisgendered peers. The Society of General Internal Medicine (SGIM) is a leading organization representing academic physicians and recognizes that significant physical and mental health inequities exist among LGBTQ + communities. As such, SGIM sees its role in improving LGBTQ + patient health through structural change, starting at the national policy level all the way to encouraging change in individual provider bias and personal actions. SGIM endorses a series of recommendations for policy priorities, research and data collection standards, and institutional policy changes as well as community engagement and individual practices to reduce bias and improve the well-being and health of LGBTQ + patients.
Collapse
Affiliation(s)
| | | | - Carl G Streed
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rita S Lee
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Viraj V Patel
- Montefiore Health System and Albert Einstein College of Medicine, New York City, NY, USA
| | - Ryan Nall
- University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
7
|
Agroia H, Smith E, Vaidya A, Rudman S, Roy M. Monkeypox (Mpox) Vaccine Hesitancy Among Mpox Cases: A Qualitative Study. Health Promot Pract 2023:15248399231215054. [PMID: 38102810 DOI: 10.1177/15248399231215054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Human mpox has been an increasing concern in the United States and California since late 2022. While the Jynneos vaccine offers a degree of cross-protection against the disease, vaccine hesitancy is common among those recommended for vaccination. The purpose of this study was to assess vaccine knowledge, facilitators, and barriers to vaccine uptake among individuals previously diagnosed with mpox, or mpox cases, in Santa Clara County, California. In-depth interviews were conducted by public health department staff among mpox cases diagnosed in Santa Clara County between July and September 2022. Responses were analyzed using a grounded theory data analysis approach. Among the 47 participants, 36 (77%) had heard of mpox before diagnosis, and of these, 20 (56%) did not think they were at risk of developing mpox, and 28 (78%) were aware that a vaccine was available. Those who did not receive the vaccine stated vaccine access and availability were the main barriers. Among the six participants not interested in the vaccine, the main hesitancies were lack of perceived risk, stigma of being branded by scarring and labeled gay, and vaccine safety. Overall, the following themes were attributed to reasons for vaccine hesitancy: (a) lack of awareness of the disease and vaccine, including perceived risks; (b) lack of vaccine availability and accessibility; and (c) stigma associated with receiving the vaccine, including being publicly labeled as "gay" and the scarring on forearm potentially seen as branding. We recommend tailoring outreach and educational campaigns to address reasons for mpox vaccine hesitancy.
Collapse
Affiliation(s)
- Harit Agroia
- County of Santa Clara Public Health Department, San Jose, CA, USA
- San Jose State University, San Jose, CA, USA
| | - Emily Smith
- County of Santa Clara Public Health Department, San Jose, CA, USA
| | - Akanksha Vaidya
- County of Santa Clara Public Health Department, San Jose, CA, USA
| | - Sarah Rudman
- County of Santa Clara Public Health Department, San Jose, CA, USA
| | - Monika Roy
- County of Santa Clara Public Health Department, San Jose, CA, USA
| |
Collapse
|
8
|
Sengupta T, Soni T, Bolock AM, Heisey SA, Kuchinski EC, Piper BJ, Joyce JM, Carbe CJ. Knowledge, Attitudes, and Beliefs of Medical Students Toward Transgender Healthcare: A Community-Driven Initiative. Cureus 2023; 15:e49992. [PMID: 38058529 PMCID: PMC10697781 DOI: 10.7759/cureus.49992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Transgender patients face substantial systemic healthcare barriers and inadequate care from providers who often demonstrate clinical gaps in the medical needs of the transgender community. Providing interventions in which affirming transgender healthcare is explored, is crucial to delivering competent transgender-patient care and building compassionate physician-patient relationships. The Northeast Pennsylvania (NEPA) Trans Health Conference was established to address the growing need for an educational forum where transgender people could voice their narratives. In this educational intervention study, changes in the knowledge, attitudes, and beliefs about the psychosocial and medical needs of the transgender community in first-year undergraduate medical students were examined pre- and post-trans health conference attendance. Materials and methods In the late spring of both 2018 and 2019, first-year medical students attended the NEPA Trans Health Conference, hosted by the Geisinger Commonwealth School of Medicine (GCSOM). Student knowledge, attitudes, and beliefs, regarding the healthcare needs of the transgender community were evaluated prior to and directly after the conference (intervention). Though the surveys shared thematic similarities, the 2018 and 2019 surveys were different and thus were not used comparatively. Results In 2018, 35.24% of first-year medical students (37/105 participants) completed both the pre- and post-survey. Overall, 62.5% (5/8) of survey items yielded significant differences. In 2019, 25.5%, of first-year medical students (28/110 participants) completed both the pre- and post-survey and 47.6% (9/21) of survey items yielded significant results. Overall, although the majority of first-year medical students displayed positive attitudes toward trans people pre-intervention, the students also demonstrated increased knowledge, empathy, and understanding of the transgender healthcare narrative post-intervention. Conclusion Providing medical students with a humanistic intervention within the medical curriculum that is focused on the transgender person, in addition to their past and present healthcare experiences, offers a bridge between academic content and providing inclusive gender-affirming healthcare to all patients.
Collapse
Affiliation(s)
- Tonoya Sengupta
- Department of Medical Education, St. George's University School of Medicine, St. George's, GRD
| | - Tripti Soni
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, USA
| | - Alexa M Bolock
- Department of Radiology, New York-Presbyterian Weill Cornell Medical College, New York, USA
| | - Sarah A Heisey
- Department of Medicine, Prisma Health Greenville Memorial Hospital, Greenville, USA
| | - Elizabeth C Kuchinski
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Jennifer M Joyce
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Christian J Carbe
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| |
Collapse
|
9
|
Reghunathan M, Thompson N, Sendek G, Butler PD, Reid CM, Gosman AA. A Practical Guide to Implementing Holistic Review during Surgery Resident Selection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5459. [PMID: 38098951 PMCID: PMC10721126 DOI: 10.1097/gox.0000000000005459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/05/2023] [Indexed: 12/17/2023]
Abstract
Provider workforce diversity is a key component of improving healthcare quality and addressing healthcare disparities. Furthermore, the traditional approach of "score-centered" application metrics do not consistently correlate with meeting milestones in surgery, nor do they adequately predict a surgical resident's clinical strength and operative abilities. We present here an adaptable process by which surgical residency programs can identify their values and incorporate holistic review into their resident selection process to improve resident selection and physician workforce diversity.
Collapse
Affiliation(s)
- Meera Reghunathan
- From the Department of Surgery, Division of Plastic Surgery, UC San Diego, San Diego, Calif
| | - Noelle Thompson
- University of Toledo College of Medicine and Life Science, Toledo, Ohio
| | - Gabriela Sendek
- From the Department of Surgery, Division of Plastic Surgery, UC San Diego, San Diego, Calif
| | - Paris D Butler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Chris M Reid
- From the Department of Surgery, Division of Plastic Surgery, UC San Diego, San Diego, Calif
| | - Amanda A Gosman
- From the Department of Surgery, Division of Plastic Surgery, UC San Diego, San Diego, Calif
| |
Collapse
|
10
|
Percival V, Thoms OT, Oppenheim B, Rowlands D, Chisadza C, Fewer S, Yamey G, Alexander AC, Allaham CL, Causevic S, Daudelin F, Gloppen S, Guha-Sapir D, Hadaf M, Henderson S, Hoffman SJ, Langer A, Lebbos TJ, Leomil L, Lyytikäinen M, Malhotra A, Mkandawire P, Norris HA, Ottersen OP, Phillips J, Rawet S, Salikova A, Shekh Mohamed I, Zazai G, Halonen T, Kyobutungi C, Bhutta ZA, Friberg P. The Lancet Commission on peaceful societies through health equity and gender equality. Lancet 2023; 402:1661-1722. [PMID: 37689077 DOI: 10.1016/s0140-6736(23)01348-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Valerie Percival
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada; The Wilson Center, Washington DC, USA.
| | - Oskar T Thoms
- Department of Political Science, University of Toronto, Mississauga, ON, Canada
| | - Ben Oppenheim
- Ginkgo Bioworks, Boston, MA, USA; New York University Center on International Cooperation, New York, NY, USA
| | - Dane Rowlands
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Carolyn Chisadza
- Department of Economics, University of Pretoria, Pretoria, South Africa
| | - Sara Fewer
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Amy C Alexander
- Quality of Government Institute, Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Chloe L Allaham
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sara Causevic
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - François Daudelin
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siri Gloppen
- University of Bergen, Bergen, Norway; LawTransform, CMI-UiB Centre on Law and Social Transformation, Bergen, Norway
| | - Debarati Guha-Sapir
- Institute of Health and Society, UC Louvain, Brussels, Belgium; Johns Hopkins Center for Humanitarian Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maseh Hadaf
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Samuel Henderson
- Department of Political Science, University of Toronto, Toronto, ON, Canada
| | | | - Ana Langer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Toni Joe Lebbos
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Luiz Leomil
- Department of Political Science, Carleton University, Ottawa, ON, Canada
| | | | - Anju Malhotra
- Center for Women's Health and Gender Equality, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Mkandawire
- Human Rights and Social Justice Program, Carleton University, Ottawa, ON, Canada
| | - Holly A Norris
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Ole Petter Ottersen
- Office of the President, Karolinska Institutet, Stockholm, Sweden; University of Oslo, Oslo, Norway
| | - Jason Phillips
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sigrún Rawet
- Department for Multilateral Development Banks, Sustainability and Climate, Ministry for Foreign Affairs, Stockholm, Sweden
| | | | - Idil Shekh Mohamed
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Ghazal Zazai
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | | | | | - Zulfiqar A Bhutta
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; The Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan; SickKids Centre for Global Child Health, Toronto, ON, Canada
| | - Peter Friberg
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
11
|
Paidisetty P, Sathyanarayanan S, Kuan-Pei Wang L, Slaughter K, Freet D, Greives M, Chen W. Assessing the Readability of Online Patient Education Resources Related to Neophallus Reconstruction. J Surg Res 2023; 291:296-302. [PMID: 37506428 DOI: 10.1016/j.jss.2023.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/07/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Online patient education materials (PEMs) often exceed the recommended 6th grade reading level. This can negatively affect transmasculine patients' understanding of treatment plans, increasing barriers to care and worsening health outcomes and patient satisfaction. This study assessed the readability of online English and Spanish PEMs regarding phalloplasty and urethroplasty. METHODS The English and Spanish terms for phalloplasty and urethroplasty were queried on Google. The first fifty results were grouped into institutional (government, medical school, teaching hospital), noninstitutional (private practice, news channel, blog, etc.), and academic (journal articles, book chapters) categories. Readability scores were generated using the Simple Measure of Gobbledygook and Spanish Simple Measure of Gobbledygook scales. RESULTS All PEMs exceeded recommended reading levels. For both procedures, English PEMs had an average reading level approximately of a university sophomore and Spanish PEMs had an average reading level approximately of a high school junior. For both procedures, English PEMs were harder to read than Spanish PEMs overall (P < 0.001) and when compared across the three categories between the two languages (P < 0.001). For Spanish urethroplasty PEMs, noninstitutional PEMs were more difficult to read than institutional PEMs (P < 0.05). CONCLUSIONS Online information for phalloplasty and urethroplasty should be revised and/or standardized materials should be created by trans-affirming health-care providers and national organizations in order to more fully educate the public and prospective patients prior to intervention. A well-informed patient population will improve patient decision-making and surgeon-patient communication, ultimately leading to better health outcomes.
Collapse
Affiliation(s)
| | | | - Leonard Kuan-Pei Wang
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Kristen Slaughter
- McGovern Medical School at UTHealth, Houston, Texas; Department of Plastic and Reconstructive Surgery, UTHealth, Houston, Texas
| | - Daniel Freet
- McGovern Medical School at UTHealth, Houston, Texas; Department of Plastic and Reconstructive Surgery, UTHealth, Houston, Texas
| | - Matthew Greives
- McGovern Medical School at UTHealth, Houston, Texas; Department of Plastic and Reconstructive Surgery, UTHealth, Houston, Texas
| | - Wendy Chen
- McGovern Medical School at UTHealth, Houston, Texas; Department of Plastic and Reconstructive Surgery, UTHealth, Houston, Texas.
| |
Collapse
|
12
|
Jonas MC, Egan K, Sheu YS, McCarthy RJ, Horberg MA. Pride Medical at Capitol Hill: A New Lesbian, Gay, Bisexual, Transgender, Queer/Questioning plus (LGBTQ+) Patient Care Option at Kaiser Permanente Mid-Atlantic States. Healthcare (Basel) 2023; 11:2816. [PMID: 37957960 PMCID: PMC10647306 DOI: 10.3390/healthcare11212816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
When accessing medical care, lesbian, gay, bisexual, transgender, queer/questioning plus (LGBTQ+) individuals face many known challenges, including stigma, discrimination, and health disparities. Transgender and nonbinary individuals often encounter physicians and staff who are not knowledgeable about gender-affirming services and the transition journey. Finding an affirming physician can be a trial-and-error process, causing concern and uncertainty. In 2021, Kaiser Permanente Mid-Atlantic States (KPMAS) researchers published a study examining the gaps in care and experience for transgender and nonbinary patients within the KPMAS healthcare system. KPMAS realized an opportunity to both close the gaps in care identified by transgender and nonbinary patients and enhance services for the broader LGBTQ+ patient community by creating Pride Medical at Capitol Hill-an additional and optional care site for individuals who identify as LGBTQ+. During the analysis timeframe of 30 June 2021 through 30 November 2022, 586 patients accessed care through 763 visits. A total of 675 visits (88%) were for primary care and 88 (12%) for OB/GYN. Over 50% (n = 384) of total visits were conducted virtually. The plurality of patients seen identified as a man (35%; n = 204) and gay (30%; n = 176). Postvisit survey results showed that 92% of survey respondents strongly agreed that the physician treated them with courtesy and respect, and 72% of survey respondents rated their overall care as excellent. Survey results show high acceptability of this program among the patients served. Pride Medical does not carve out care. The program offers patients access to a more specialized team of physicians-a similar model to other specialties-that is easily found by the division name Pride Medical. Layering additional specialty divisions on top of existing care, for interested patients, could be an option for other medical groups and health systems seeking to offer additional options of care for interested LGBTQ+ patients.
Collapse
Affiliation(s)
- Mary Cabell Jonas
- Mid-Atlantic Permanente Research Institute, Rockville, MD 20852, USA
| | - Keith Egan
- Mid-Atlantic Permanente Medical Group, Rockville, MD 20852, USA
| | - Yi-Shin Sheu
- Mid-Atlantic Permanente Research Institute, Rockville, MD 20852, USA
| | | | | |
Collapse
|
13
|
Tanenbaum GJ, Holden LR. A Review of Patient Experiences and Provider Education to Improve Transgender Health Inequities in the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6949. [PMID: 37887687 PMCID: PMC10606079 DOI: 10.3390/ijerph20206949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate healthcare. These inequities are proposed here to be rooted in a lack of education about transgender people and their experiences. We begin by exploring the existing transgender healthcare research carried out in the USA, examining client experiences, provider education and attitudes, and the barriers transgender people face to obtaining proper healthcare. Secondly, we look at the previous research on educational interventions implemented with medical students and practitioners in the USA to enhance knowledge about transgender people, and increase sensitivity and awareness, while also increasing the level of comfort in working with these clients. The limitations in these fields of study are discussed in order to understand how to better serve transgender clients in the USA. We will do this through a narrative review to determine evidence-based best practices for educational intervention, uncovering gaps in the literature and highlighting where to focus in future work for researchers and practitioners.
Collapse
Affiliation(s)
- Gabriel J. Tanenbaum
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA;
| | - LaTasha R. Holden
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA;
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
| |
Collapse
|
14
|
da Silva ACG, Lins-Kusterer L, Luz E, Brites C. Development and Validation of a Transgender Health Care Humanization Scale. Transgend Health 2023; 8:444-449. [PMID: 37810935 PMCID: PMC10551756 DOI: 10.1089/trgh.2021.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Stigma and discrimination against transgender people can lead to their segregation. Fighting stigma and discrimination is a crucial strategy to expand access to health services. The goals of the present study were to develop and validate a transgender health care humanization scale (THcH scale) to evaluate the perception of humanization in health care for transgender individuals. Methods This cross-sectional study included 340 health care providers aged ≥18 years. Participants answered a structured questionnaire when attending HIV/AIDS scientific meetings or at their place of work. An exploratory factor analysis was conducted, using a polychoric matrix and robust diagonally weighted least squares extraction method. The number of retained factors was defined through the parallel analysis technique, with random permutation of the observed data and the use of Robust Promin rotation. Results The interpretability of correlation matrix items was suggested by the Bartlett's sphericity tests (1633.7, df=91; p<0.001) and Kaiser-Meyer-Olkin Test (0.875). The factor structure showed adequate adjustment indices (χ2=44,200, df=52; root mean square error of approximation p<0.05; comparative fit index=0.968; Tucker-Lewis index=0.945; goodness-of-fit index = 0.995). Only one factor was retained by parallel analysis, explained by 54.17% of the variance of the construct and confirmed by the following indices: unidimensional congruence=0.902, explained common variance=0.828, and mean of item residual absolute loadings=0.279. Good reliability was confirmed by Cronbach's alpha test (0.899). Conclusion The THcH scale showed good psychometric properties. This self-report questionnaire, which can be completed in 5 min, may be useful in scientific research and could guide health care providers in expansion of a Health Humanization Policy and in deconstructing prejudice against transgender people in health care settings.
Collapse
Affiliation(s)
- Ana Clara Guimarães da Silva
- LAPI-Laboratório de Pesquisa em Infectologia, Federal University of Bahia, Hospital Universitário Professor Edgard Santos, Salvador, Brazil
- Post-Graduation Program in Medicine and Health, School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Liliane Lins-Kusterer
- LAPI-Laboratório de Pesquisa em Infectologia, Federal University of Bahia, Hospital Universitário Professor Edgard Santos, Salvador, Brazil
- Post-Graduation Program in Medicine and Health, School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Estela Luz
- LAPI-Laboratório de Pesquisa em Infectologia, Federal University of Bahia, Hospital Universitário Professor Edgard Santos, Salvador, Brazil
- Post-Graduation Program in Medicine and Health, School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Carlos Brites
- LAPI-Laboratório de Pesquisa em Infectologia, Federal University of Bahia, Hospital Universitário Professor Edgard Santos, Salvador, Brazil
- Post-Graduation Program in Medicine and Health, School of Medicine, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
15
|
Burcheri A, Coutin A, Bigham BL, Kruse MI, Lien K, Lim R, MacCormick H, Morris J, Ng V, Primiani N, Odorizzi S, Poirier V, Upadhye S, Primavesi R. Exploring a case for education about sexual and gender minorities in postgraduate emergency medicine training: forming recommendations for change. Postgrad Med 2023; 135:623-632. [PMID: 37310186 DOI: 10.1080/00325481.2023.2225329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/12/2023] [Indexed: 06/14/2023]
Abstract
Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.
Collapse
Affiliation(s)
- Adam Burcheri
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Alexandre Coutin
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Blair L Bigham
- Department of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kelly Lien
- Departments of Emergency Medicine and Family Medicine, Western University, London, ON, Canada
| | - Rodrick Lim
- Department of Pediatrics and Medicine, Western University, London, ON, Canada
| | - Hilary MacCormick
- Departments of Anesthesia, Pain Management, & Perioperative Medicine, Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Judy Morris
- Departments of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | - Victor Ng
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Nadia Primiani
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Scott Odorizzi
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vincent Poirier
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert Primavesi
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
16
|
Nowaskie DZ. Evaluation of the Three National Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority (LGBTQ+)-Competent Provider Directories in the United States. JOURNAL OF HOMOSEXUALITY 2023; 70:1718-1724. [PMID: 35179444 DOI: 10.1080/00918369.2022.2040930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Provider directories may serve as a bridge solution until lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) education becomes a requisite within standard medical education. The three national LGBTQ+-competent provider directories in the United States were evaluated. Two directories served the LGBTQ+ community while one served the gender minority community. All enumerated thousands of providers. One allowed provider-specific feedback. All provided searchable criteria (e.g., provider name, location, specialty, population identity, service type, payment types, gender identity, and languages spoken). By implementing these key features, existing and future directories could better provide equitable healthcare access for the LGBTQ+ population.
Collapse
Affiliation(s)
- Dustin Z Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
17
|
Association of Affirming Care with Chronic Disease and Preventive Care Outcomes among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults. Am J Prev Med 2023; 64:305-314. [PMID: 36460525 DOI: 10.1016/j.amepre.2022.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Experiences of discrimination and bias in healthcare contribute to health disparities for lesbian, gay, bisexual, transgender, and queer populations. To avoid discrimination, many go to great lengths to find healthcare providers who they trust and who are knowledgeable about their health needs. This study examines whether access to an affirming provider improves health outcomes for lesbian, gay, bisexual, transgender, and queer populations across a range of preventive health and chronic disease management outcomes. METHODS This cross-sectional study uses Poisson regression models to examine original survey data (n=1,120) from Wave 1 of the Vanderbilt University Social Networks, Aging, and Policy Study, a panel study examining older (aged 50-76 years) lesbian, gay, bisexual, transgender, and queer adults' health and aging, collected between April 2020 and September 2021. RESULTS Overall, access to an affirming provider is associated with greater uptake of preventive health screenings and improved management of mental health conditions. Participants with an affirming provider are more likely to have ever and recently received several types of preventive care than participants reporting a usual source of care that is not affirming, including past year provider visit, influenza vaccination, colorectal cancer screening, and HIV test. Access to an affirming provider is also associated with better management of mental health conditions. CONCLUSIONS Inclusive care is essential for reducing health disparities among lesbian, gay, bisexual, transgender, and queer populations. Health systems can reduce disparities by expanding continuing education opportunities; adopting nondiscrimination policies for patients and employees; and ensuring that necessary care is covered by health insurance.
Collapse
|
18
|
Reddy A. Transgender Healthcare and Medical Education: An Inductive Thematic Analysis of Digital Discourse. Cureus 2023; 15:e34972. [PMID: 36938253 PMCID: PMC10019934 DOI: 10.7759/cureus.34972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Transgender and gender-diverse (TGD) patients face significant healthcare disparities informed by discrimination, social stigma, and socioeconomic inequality. This is further exacerbated by a paucity of transgender health content in medical education, contributing to a large proportion of providers being ill-equipped to manage TGD patients' health concerns. Method This paper uses the framework approach for an inductive thematic analysis of online discussion forums concerning transgender health and medical education. Online text from anonymous participants was chosen for their authentic accounts of healthcare experiences and to ensure responses are less restrained in discussing sensitive topics. Results Three major themes were identified from the data: desire for more knowledgeable providers, negative healthcare experiences and attitudes, and recommendations for transgender health education. Three subcategories emerged from the latter theme that further illuminated participant recommendations for inclusive healthcare. Conclusions As a result of the unique healthcare concerns faced by TGD patients, providing materials to educate students and providers is crucial to meet the needs of the TGD patient population. Participant reports align with previous literature in recommending curricular reforms in medical school, promoting career options for TGD-identifying people in healthcare, and cultivating a more inclusive clinical culture.
Collapse
Affiliation(s)
- Aakash Reddy
- College of Natural Sciences, University of Texas at Austin, Austin, USA
| |
Collapse
|
19
|
Harrop EN, Hecht HK, Harner V, Call J, Holloway BT. "How Do I Exist in This Body…That's Outside of the Norm?" Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1156. [PMID: 36673911 PMCID: PMC9859328 DOI: 10.3390/ijerph20021156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 06/01/2023]
Abstract
Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark's thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings.
Collapse
Affiliation(s)
- Erin N. Harrop
- Graduate School of Social Work, University of Denver, Denver, CO 80208, USA
| | - Hillary K. Hecht
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Vern Harner
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA 98104, USA
- School of Social Work and Criminal Justice, University of Washington Tacoma, Tacoma, WA 98402, USA
| | - Jarrod Call
- School of Social Work and Criminal Justice, University of Washington Tacoma, Tacoma, WA 98402, USA
| | | |
Collapse
|
20
|
Hernandez AL, Weatherly CS, Burrowes S, Jimenez JL, Gonzalez R, Palefsky JM. “The problem is that our culture is just so messed up about aging.” Recruiting older men who have sex with men (MSM) into research studies: an example from a study of aging, HIV, and anal HPV. BMC Med Res Methodol 2022; 22:296. [DOI: 10.1186/s12874-022-01752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 07/11/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Anal human papillomavirus (HPV) disproportionately affects men who have sex with men (MSM), particularly those who are older and those living with HIV. After experiencing difficulty recruiting older MSM into a study on aging and anal HPV, we conducted a sub-study to gain feedback on our recruitment methods and explore barriers and facilitators to participating in anal HPV research.
Methods
We conducted focus groups with 30 men who have sex with men (MSM), both HIV-negative and MSM living with HIV, ages 50–75.
Results
We identified multiple themes that were barriers to participation including: (1) lack of knowledge about human papillomavirus and anal cancer; (2) research focused on anal cancer or discomfort with topics or procedures concerning the anus; (3) stigma including stigma associated with being men who have sex with men, being out, being a receptive partner, and being considered “older” in the gay community; and (4) confidentiality concerns including a fear of breach of confidentiality. Facilitators to participation were also identified; these motivational factors include altruism, wanting recommendations from a doctor, and desire to receive the best available care.
Conclusion
Researchers seeking to enroll older men who have sex with men should be aware of these barriers and facilitators to participation in order to maximize recruitment.
Collapse
|
21
|
Schmidt CN, Stretten M, Bindman JG, Pettigrew G, Lager J. Care across the gender spectrum: A transgender health curriculum in the Obstetrics and Gynecology clerkship. BMC MEDICAL EDUCATION 2022; 22:706. [PMID: 36199074 PMCID: PMC9535842 DOI: 10.1186/s12909-022-03766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A lack of undergraduate medical curricula on providing healthcare to transgender and gender diverse (TGD) patients has contributed to significant health disparities for TGD communities. To address this gap, we designed and evaluated a novel curriculum to train Obstetrics and Gynecology (OB/GYN) clerkship students in caring for TGD patients. METHODS Following Kern's 6-step method for curriculum development, we created a two-part curriculum on TGD healthcare topics - an online module on gender-affirming care, followed by a series of interactive cases on TGD-specific health topics. Undergraduate medical students completing their core OB/GYN clerkships at a university academic medical center (January-December 2021) were invited to complete this curriculum. Participants completed pre/post assessment surveys to assess their experience caring for TGD patients, as well as a scored knowledge assessment before and after completing the curriculum. RESULTS Sixty-five students participated in this curricular assessment. Prior to completing the module, 45% agreed that they had received adequate TGD health training. Following module completion, students reported increased comfort in caring for transgender patients (49.2% vs. 81.5%; p < .001) and endorsed an improved fund of knowledge of both healthcare maintenance for TGD patients (61.5% vs. 100%; p < .001) and gender affirming medical therapies (60.0% vs. 96.9%; p < .001). Knowledge scores increased from a mean of 9.65 (1.81) to 12.5 (2.20) out of 15 (p < .001). In post-assessment surveys, 95% of participants agreed that the module was helpful for their learning. Qualitatively, students suggested longitudinal integration of TGD-topics into the pre-clinical curriculum, and expanded opportunities to practice patient counseling. CONCLUSION The findings of this study support the need for student education on TGD health. Integration of interactive, case-based TGD-care curricula into clinical training may increase medical students' knowledge and comfort in caring for TGD patients. Ongoing efforts to integrate TGD health training into undergraduate medical student curricula are necessary.
Collapse
Affiliation(s)
- Christina N Schmidt
- School of Medicine, University of California San Francisco, San Francisco, USA.
- , 513 Parnassus Ave, S-221, San Francisco, CA, USA.
| | - Monica Stretten
- School of Medicine, University of California San Francisco, San Francisco, USA
| | - Jay G Bindman
- School of Medicine, University of California San Francisco, San Francisco, USA
| | - Gaetan Pettigrew
- Department of Obstetrics, Gynecology and Reproductive Services, University of California San Francisco, San Francisco, USA
| | - Jeannette Lager
- Department of Obstetrics, Gynecology and Reproductive Services, University of California San Francisco, San Francisco, USA
| |
Collapse
|
22
|
Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 502] [Impact Index Per Article: 251.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
Collapse
Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
23
|
McKay T, Akré ER, Henne J, Kari N, Conway A, Gothelf I. LGBTQ+ Affirming Care May Increase Awareness and Understanding of Undetectable = Untransmittable among Midlife and Older Gay and Bisexual Men in the US South. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10534. [PMID: 36078248 PMCID: PMC9518313 DOI: 10.3390/ijerph191710534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Tara McKay
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
| | | | | | - Nitya Kari
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
| | - Adam Conway
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
| | - Isabel Gothelf
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
| |
Collapse
|
24
|
Hermosillo D, Cygan HR, Lemke S, McIntosh E, Vail M. Achieving Health Equity for LGBTQ+ Adolescents. J Contin Educ Nurs 2022; 53:348-354. [PMID: 35914274 DOI: 10.3928/00220124-20220706-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.].
Collapse
|
25
|
Assessing the Information-Motivation-Behavioral Skills Model to Predict Pre-exposure Prophylaxis Adherence Among Black Men Who have Sex with Men and Transgender Women in a Community Setting in New York City. AIDS Behav 2022; 26:2494-2502. [PMID: 35098392 DOI: 10.1007/s10461-022-03588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/01/2022]
Abstract
The Information-Motivation-Behavioral Skills (IMB) Model has been used to understand adherence to medications and intentions to uptake pre-exposure prophylaxis (PrEP) to prevent HIV infection. In the current study, the IMB Model was used to understand factors that predict adherence to PrEP among a community-based cohort of 204 Black men who have sex with men (MSM) and transgender women (TGW) using structural equation modeling. PrEP motivation was directly associated with PrEP behavioral skills (β = 0.320, p = 0.009), and PrEP behavioral skills were directly associated with PrEP adherence (β = 0.416, p = 0.001). PrEP knowledge and PrEP motivation were not associated with PrEP adherence, directly or indirectly. The analysis identified intervenable factors that predicted PrEP adherence. Screening for motivation and behavioral skills could be used to identify where additional support to improve PrEP adherence is needed, or whether to offer alternative PrEP modalities or delivery strategies.
Collapse
|
26
|
Goldbach JT, Kipke MD. What affects timely linkage to HIV Care for Young Men of Color who have sex with Men? Young Men's Experiences Accessing HIV Care after Seroconverting. AIDS Behav 2022; 26:4012-4025. [PMID: 35672551 DOI: 10.1007/s10461-022-03727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
The HIV care continuum provides intervention points that should be addressed to optimally identify, engage, and retain populations in HIV care. This study addressed the lack of research into barriers and facilitators of linkage to care for HIV-positive young men who have sex with men (YMSM) of color. Data were collected using a qualitative timeline follow-back interview approach with YMSM who had seroconverted in the last 6 months. Interviews were conducted with 15 YMSM from April 2017 to April 2018. This study provides important information about what can delay linkage to care for YMSM of color. These delays include fractured referrals to care providers via mobile HIV testing vans, adapting to an HIV diagnosis and integrating it into their lives, and finding caring and competent providers that offer wraparound services, specifically mental health services, as soon as possible after an HIV diagnosis. Addressing these issues is imperative to optimize YMSM's engagement in the HIV care continuum and work toward ending the epidemic.
Collapse
Affiliation(s)
- Jeremy T Goldbach
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, 63130, St. Louis, MO, United States.
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| |
Collapse
|
27
|
Schwartz J, Grimm J, Zimmerman R, Clement M. Information Seeking and MSM's Beliefs about PrEP and Condoms. HEALTH COMMUNICATION 2022; 37:889-896. [PMID: 33494635 DOI: 10.1080/10410236.2021.1876323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study examined how frequently men who have sex with men (MSM) used a selection of sources, including news media, social media, health organizations, and dating/hookup apps, for HIV information. Additionally, the study explored the extent to which MSM's efficacy beliefs about pre-exposure prophylaxis (PrEP) and perceptions of condom importance could be predicted by the sources they used. A sample of MSM (N= 969) were surveyed online. Results showed that respondents obtained information about HIV most often from HIV organizations, LGBT organizations, and dating/hookup apps, particularly the apps Growlr, Scruff, and Grindr. Use of the app Scruff was the strongest source-based predictor of beliefs about both PrEP and condoms. Implications for health promotion are discussed.
Collapse
Affiliation(s)
- Joseph Schwartz
- Department of Communication Studies, Northeastern University
| | - Josh Grimm
- Manship School of Mass Communication, Louisiana State University
| | | | | |
Collapse
|
28
|
Everhart AR, Ferguson L, Wilson JP. Construction and validation of a spatial database of providers of transgender hormone therapy in the US. Soc Sci Med 2022; 303:115014. [PMID: 35594740 DOI: 10.1016/j.socscimed.2022.115014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/04/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
What little data on transgender healthcare is available often focuses on transgender people's negative experiences in accessing healthcare. However, no research has been conducted that illustrates where gender-affirming hormone therapy, one part of transgender-specific medical care, is available. Without these data, large scale research to discern patterns of availability of and access to gender-affirming medical care is nearly impossible. Community-based organizations, and even trans individuals themselves have constructed repositories and databases of healthcare providers to inform other care seekers where they can access transition-related care providers, but their data are often incomplete, and usually formatted to be user-facing rather than streamlined for research purposes. To fill this gap, this article outlines the methodology for the construction of a spatial database of providers of gender-affirming hormone therapy for transgender people in the US, which is available on GitHub, created from existing community-based resources and the accompanying verification process. The completeness of the database is tested via comparison to data from the US Transgender Survey in which respondents reported travel distance to access transgender-specific care providers. The database accounted for all but 7.5% of respondents who may have accessed unknown facilities based on self-reported travel distance. Results indicate that existing methodologies for database construction regarding healthcare providers are difficult to apply when working with transgender-specific medical care and that tests for replicability and validation often take for granted the wide availability of relevant data and information. While the database unto itself can only demonstrate where care is available, it will enable future research into why these geographic patterns in care availability exist. Finally, the methodology can be replicated to produce databases for other kinds of specialized or politicized medical care such as abortion, gender-affirming surgery, or HIV treatment.
Collapse
Affiliation(s)
- Avery R Everhart
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA; Center for Applied Transgender Studies, Chicago, IL, USA.
| | - Laura Ferguson
- University of Southern California, Keck School of Medicine, Institute on Inequalities in Global Health, 2001 N Soto St, Los Angeles, CA, 90032, USA.
| | - John P Wilson
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA.
| |
Collapse
|
29
|
Alcindor ML. What are the perceptions of healthcare providers on the healthcare needs of transgender and gender-diversified people and stigma-related attitudes? Evid Based Nurs 2022; 25:ebnurs-2021-103498. [PMID: 35589371 DOI: 10.1136/ebnurs-2021-103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
|
30
|
Rhoten B, Burkhalter JE, Joo R, Mujawar I, Bruner D, Scout N, Margolies L. Impact of an LGBTQ Cultural Competence Training Program for Providers on Knowledge, Attitudes, Self-Efficacy, and Intensions. JOURNAL OF HOMOSEXUALITY 2022; 69:1030-1041. [PMID: 33905307 DOI: 10.1080/00918369.2021.1901505] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper describes the development and implementation of a robust lesbian, gay, bisexual, transgender, and queer (LGBTQ) cultural competence curriculum for training health and human service providers across New York State. Between 2013-2018, The National LGBT Cancer Network developed and published Best Practices in Creating and Delivering LGBTQ Cultural Competency Trainings for Health and Social Service Agencies and designed a training curriculum. They also conducted Train the Trainer sessions, and evaluated pre- and post- curriculum knowledge, attitudes, self-efficacy and intentions of individuals who attended educational sessions conducted by the certified trainers. Most respondents improved from pretest to posttest, with significant improvements in knowledge, attitudes, self-efficacy and intentions. An increase in self-efficacy was significantly associated with pre- to posttest improvement in respondent intention. Future research should focus on what components specifically bolster self-efficacy and intention. Increasing the number of health and human service providers who are trained to address the needs of this population is an important step toward providing culturally competent care.
Collapse
Affiliation(s)
- Bethany Rhoten
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | | | - Rej Joo
- National LGBT Cancer Network, New York, New York, USA
| | - Imran Mujawar
- Centers for Disease Control and Prevention, Washington, DC, USA
| | | | - Nfn Scout
- National LGBT Cancer Network, New York, New York, USA
| | - Liz Margolies
- National LGBT Cancer Network, New York, New York, USA
| |
Collapse
|
31
|
Hojilla JC, Hurley LB, Marcus JL, Satre DD, Silverberg MJ, Zaritsky EF, Getahun D, Goodman M, Volk JE. HIV Pre-exposure Prophylaxis Continuum of Care Among Transgender Individuals in an Integrated Health care System. J Acquir Immune Defic Syndr 2022; 89:e30. [PMID: 34723924 PMCID: PMC8837673 DOI: 10.1097/qai.0000000000002853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J. Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Leo B. Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | - Eve F. Zaritsky
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Centre, Oakland, CA, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan E. Volk
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Centre, San Francisco, CA, USA
| |
Collapse
|
32
|
Daily Marijuana Use Predicts HIV Seroconversion Among Black Men Who Have Sex with Men and Transgender Women in Atlanta, GA. AIDS Behav 2022; 26:2503-2515. [PMID: 35094179 DOI: 10.1007/s10461-022-03598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/01/2022]
Abstract
We evaluated whether different types of substance use predicted HIV seroconversion among a cohort of 449 Black men who have sex with men (MSM) and transgender women (TGW). A community-based sample was recruited in Atlanta, GA between December 2012 and November 2014. Participants completed a survey and were tested for STIs (Chlamydia and gonorrhoeae using urine samples and rectal swabs) at baseline. HIV testing was conducted at 12-months post enrollment. Multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between substance use and HIV seroconversion. By 12-month follow-up, 5.3% (n = 24) of participants seroconverted. In multivariable analyses, daily marijuana use was positively associated with HIV seroconversion (aOR 3.07, 95% CI 1.11-8.48, P = 0.030). HIV incidence was high and daily marijuana use was associated with a more than threefold increased odds of HIV seroconversion among a community-based cohort of Black MSM and TGW.
Collapse
|
33
|
Education about sexual and gender minorities within Canadian emergency medicine residency programs. CAN J EMERG MED 2022; 24:135-143. [PMID: 34985648 DOI: 10.1007/s43678-021-00236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/16/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The CAEP 2021 2SLGBTQIA +i panel sought whether a gap exists within Canadian emergency medicine training pertaining to sexual and gender minority communities. This panel aimed to generate practical recommendations on improving emergency medicine education about sexual and gender minorities, thereby improving access to equitable healthcare. METHODS From August 2020 to June 2021, a panel of emergency medicine practitioners, residents, students, and community representatives met monthly via videoconference. A literature review was undertaken, and three mixed methods surveys were distributed to the CAEP member list, CAEP Resident Section, College of Family Physicians of Canada (CFPC)iii Emergency Medicine Members Interest Group, and to emergency medicine residency program directors and their residents. Informed by the review and surveys, recommendations were drafted and refined by panel members before presentation at the 2021 CAEP Academic Symposium. A plenary was presented to symposium attendees composed of national emergency medicine community members, which reported the survey results and literature review. All attendees were divided into small groups to develop an action plan for each recommendation. CONCLUSIONS The panel outlines eight recommendations for closing the curricular gap. It identifies three perceived or real barriers to the inclusion of sexual and gender minority content in emergency medicine residency curricula. It acknowledges three enabling recommendations that are beyond the scope of individual emergency medicine programs or emergency departments (EDs), that if enacted would enable the implementation of the recommendations. Each recommendation is accompanied by two action items as a guide to implementation. Each of the three barriers is accompanied by two action items that offer specific solutions to overcome these obstacles. Each enabling recommendation suggests an action that would shift emergency medicine towards sociocultural competence nationally. These recommendations set the primary steps towards closing the educational gap.
Collapse
|
34
|
Schwartz J, Grimm J. Communication Strategies for Discussing PrEP with Men Who Have Sex with Men. JOURNAL OF HOMOSEXUALITY 2022; 69:61-74. [PMID: 32841104 DOI: 10.1080/00918369.2020.1813509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
HIV continues to be a pressing problem, particularly for men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a highly effective means of preventing HIV infection, but adoption of it by MSM has been sluggish. Though there are many reasons for PrEP's limited adoption, healthcare providers' lack of skill in communicating with MSM likely plays a role. This study employed in-depth interviews with MSM who have adopted PrEP to explore how effective patient-provider communication surrounding PrEP takes place. Findings revealed that healthcare providers utilized five strategies to communicate with their MSM patients about PrEP. These strategies included (1) disclosure of identity and personal information; (2) knowledge of information that may be relevant to MSM patients; (3) positivity; (4) relationship inquiries; and (5) remaining calm. Employing the strategies uncovered in this study may be useful in improving communication between healthcare providers and their MSM patients and may help to increase MSM's adoption of PrEP.
Collapse
Affiliation(s)
- Joseph Schwartz
- Department of Communication Studies, Northeastern University, Boston, Massachusetts, USA
| | - Josh Grimm
- Manship School of Journalism, Louisiana State University, Baton Rouge, Louisiana, USA
| |
Collapse
|
35
|
Paguio JA, Golbin JM, Yao JS, Eala MA, Dee EC, Yu MG. Self-reported cultural competency measures among patients with diabetes: A nationwide cross-sectional study in the United States. LANCET REGIONAL HEALTH. AMERICAS 2021; 7:100158. [PMID: 36777658 PMCID: PMC9904095 DOI: 10.1016/j.lana.2021.100158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Culturally tailored interventions may reduce disparities in diabetes care. We conducted a nationally representative assessment of self-reported cultural competency measures of care among patients with diabetes in the United States. Methods The 2017 National Health Interview Survey was queried for adults with self-reported diabetes. Sample weight-adjusted multivariable logistic regressions defined adjusted odds ratios and 95% confidence intervals of a positive response to each of the cultural competency measures while controlling for relevant sociodemographic variables. Findings 2,448 adults were included in the analyses. Black, Latinx, and Asian respondents had greater odds of and individuals with the highest income level had lower odds of placing greater importance in sharing cultures with their provider. Black and Latinx individuals had lower odds of reporting encountering providers who shared or understood their cultures. Asians had lower odds of and respondents aged 40-64 and 65 years and older had greater odds of reporting frequently being treated with respect by their providers. Non-English speakers had lower odds of and individuals from higher income brackets had greater odds of reporting frequently receiving easy-to-understand information about their care. Blacks and respondents not part of the workforce had greater odds of reporting frequently being asked about their opinions or beliefs in care. Interpretation Disparities in self-reported provider cultural competency measures exist among cultural minorities in the United States. Our findings may inform efforts to reduce disparities and improve care among minorities with diabetes. Funding No funding was used in the preparation of this work.
Collapse
Affiliation(s)
| | - Jem Marie Golbin
- University of the Philippines College of Medicine, Manila, Philippines
| | | | - Michelle Ann Eala
- University of the Philippines College of Medicine, Manila, Philippines
| | - Edward Christopher Dee
- Memorial Sloan Kettering Cancer Center, NY, USA,Harvard Medical School, Boston, MA, USA
| | - Marc Gregory Yu
- Harvard Medical School, Boston, MA, USA,Joslin Diabetes Center, Boston, MA, USA
| |
Collapse
|
36
|
Roth LT, Catallozzi M, Soren K, Lane M, Friedman S. Bridging the Gap in Graduate Medical Education: A Longitudinal Pediatric Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Health Curriculum. Acad Pediatr 2021; 21:1449-1457. [PMID: 34098174 DOI: 10.1016/j.acap.2021.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 05/05/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Despite known health disparities, there is limited training in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) health, particularly in pediatric graduate medical education (GME). We aimed to develop a longitudinal LGBTQ curriculum for a pediatrics residency program tailored to the needs and interests of our trainees. METHODS We developed a year-long curriculum based on a formal needs assessment and evaluated changes in provider knowledge, comfort, and self-reported clinical impact through pre- and postsurveys. RESULTS The needs assessment was completed by 78 out of 110 providers (70.9% response rate); 60 (54.5%) and 70 (63.6%) completed the pre- and postcurriculum surveys, respectively. Postcurriculum implementation, there was an increase in mean comfort level asking about sexual orientation (4.1-4.5, P < .01), gender identity (3.5-3.8, P = .02), and sexual practices (3.4-3.8, P < .01), psychosocial screening (3.2-4.2, P < .01), applying medical/preventive screening guidelines (2.4-3.6, P < .01), and medically managing transgender patients (1.9-3.1, P < .01). Knowledge-based assessments increased from 25.2% correct to 38.5% (P = .01). Faculty felt significantly more comfortable teaching this material to trainees (21.7-70.0%, P < .01). Providers reported high scores regarding impact on clinical practice (4.0 of 5), intent to change practice (4.5 of 5), importance of (4.8 of 5) and satisfaction with (4.5 of 5) the curriculum. CONCLUSIONS There is a need to incorporate formal LGBTQ health training in GME. Our curriculum improved provider knowledge, comfort, self-reported clinical practice, and faculty preparedness to teach this material. It can serve as a framework for other pediatric programs to develop their own curricula.
Collapse
Affiliation(s)
- Lauren T Roth
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY.
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Karen Soren
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Mariellen Lane
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Suzanne Friedman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
37
|
Nowaskie DZ. 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. JMIR Form Res 2021; 5:e17913. [PMID: 34550083 PMCID: PMC8495572 DOI: 10.2196/17913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/13/2020] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Dustin Z Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| |
Collapse
|
38
|
Roth LT, Garcia M, Soren K, Catallozzi M. An unmet need for paediatric LGBTQ training. CLINICAL TEACHER 2021; 18:547-551. [PMID: 34327832 DOI: 10.1111/tct.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth have increased health risks, exacerbated by discrimination and lack of provider training. Currently, no graduate medical education requirements address the need for LGBTQ health training, particularly for paediatric providers. We aimed to perform a needs assessment of provider knowledge, comfort and awareness of community resources regarding LGBTQ youth. METHODS We administered two anonymous surveys from May to October 2017. The first survey of 73 residents assessed awareness of community resources and comfort providing referrals. A second survey of 110 trainees and faculty assessed comfort and knowledge regarding paediatric LGBTQ health. RESULTS In the first survey of residents regarding community resources (n = 30, 41% response rate), most did not know where to refer LGBTQ patients for mental health care (67%), transgender care (73%), support groups (87%), emergency shelters (86%) or family resources (87%). Ninety-seven per cent would refer to the social worker. In the second survey of trainees and faculty (n = 78, 71% response rate), most had little or no knowledge regarding pre-exposure prophylaxis (60%), post-exposure prophylaxis (54%), strategies for coming out (68%), homelessness/environmental risks (59%), gender dysphoria (63%), puberty blockade (77%), hormonal (78%) and surgical (81%) transitioning, domestic violence (58%), EMR logistics (89%) and community resources (80%). Only 33% felt very comfortable eliciting a history about sexual orientation, 13% about gender identity and 14% about sexual practices. CONCLUSION There is a clear need and desire for dedicated paediatric LGBTQ health training in graduate medical education. Residents and faculty need resources and training to better care for LGBTQ youth.
Collapse
Affiliation(s)
- Lauren T Roth
- Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marco Garcia
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York, USA
| | - Karen Soren
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Marina Catallozzi
- Department of Pediatrics, Population and Family Health, Columbia University Irving Medical Center, New York City, New York, USA
| |
Collapse
|
39
|
Behavioral Health in the Lesbian, Gay, Bisexual, Transgender, Questioning, and Other as Sexual and Gender Identities Community. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
40
|
Scalia P, Tighe KM, Elwyn G, Bagley PJ, Blunt HB, Boh B, Walters OC, Moses RA. A systematic review of decision aids for gender affirming therapy. Transl Androl Urol 2021; 10:2574-2582. [PMID: 34295744 PMCID: PMC8261453 DOI: 10.21037/tau-20-1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transgender and gender diverse (TGD) persons considering gender affirming therapy have to make many complex medical decisions, potentially without understanding the associated harms or benefits of hormonal and surgical interventions. Further, clinicians are often unaware of how best to communicate information to persons seeking gender affirming therapy. Patient decision aids have been developed to provide evidence-based information as a way to help people make decisions in collaboration with their clinicians. It is unclear whether such tools exist for persons seeking gender affirming therapy. The objective of our systematic review is to search for and determine the quality of any existing patient decision aids developed for TGD persons considering gender affirming therapy, and the outcomes associated with their use. METHODS We adapted a search strategy for databases using two key concepts "decision support intervention/patient decision aid" and "transgender". We also conducted a brief online search of Google and abstracts from relevant conferences to identify any tools not published in the academic literature. Following study selection and data extraction, we used the International Patient Decision Aid Standards instrument (IPDASi) to assess the quality of patient decision aids, and the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) checklist to assess the quality of evaluations. RESULTS We identified 762 studies; none were identified from Google or conference content. One tool met our inclusion criteria: an online, pre-encounter patient decision aid for transmasculine genital gender-affirming surgery developed in Amsterdam, translated in English and Dutch. The tool met all the IPDASi qualifying criteria, and scored a 17/28 on the certification criteria, and 57/112 on the quality criteria. The efficacy of the patient decision aid has not been evaluated. CONCLUSIONS Despite multiple decisions required for gender affirming therapies, only one patient decision aid has been developed for transmasculine genital reconstruction. Further research is required to develop patient decision aids for the multiple decision points along the gender affirming journey.
Collapse
Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Katherine M. Tighe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | | | - Benjamin Boh
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | |
Collapse
|
41
|
Misinformation, Gendered Perceptions, and Low Healthcare Provider Communication Around HPV and the HPV Vaccine Among Young Sexual Minority Men in New York City: The P18 Cohort Study. J Community Health 2021; 45:702-711. [PMID: 32016677 DOI: 10.1007/s10900-019-00784-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection among adults in the United States, and can cause several types of cancer. This is of particular concern for sexual minority men, as their increased risk of HIV acquisition increases risk for HPV and HPV-associated cancers, particularly when coupled with low rates of HPV vaccination. As part of a larger study of the syndemic of HIV, substance use, and mental health among young sexual minority men in New York City, we sought to explore what sexual minority men know about HPV and the HPV vaccine, along with their experiences have been communicating about the virus and vaccine. We interviewed 38 young sexual minority men with diverse sociodemographic characteristics and identified three main themes: low knowledge about HPV infection and vaccination, highly gendered misconceptions about HPV only affecting women, and lack of communication from healthcare providers about HPV. The prevalence of incorrect HPV knowledge, coupled with inadequate education and vaccination in healthcare settings, indicates a missed opportunity for HPV prevention in a high-risk and high-need population.
Collapse
|
42
|
Guerrero-Hall KD, Muscanell R, Garg N, Romero IL, Chor J. Obstetrics and Gynecology Resident Physician Experiences with Lesbian, Gay, Bisexual, Transgender and Queer Healthcare Training. MEDICAL SCIENCE EDUCATOR 2021; 31:599-606. [PMID: 34457914 PMCID: PMC8368479 DOI: 10.1007/s40670-021-01227-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To assess obstetrician-gynecologist (Ob/Gyn) resident experiences with and preferences for lesbian, gay, bisexual, transgender, and queer (LGBTQ) healthcare training. METHODS A cross-sectional, web-based survey was deployed to residents from accredited Illinois Ob/Gyn training programs. The survey included 32 questions on resident demographics, LGBTQ training, and self-perceived preparedness in providing LGBTQ patient care. RESULTS Of 257 eligible Ob/Gyn residents, 105 (41%) responded. Fifty percent of residents felt unprepared to care for lesbian or bisexual patients and 76% felt unprepared to care for transgender patients. Feeling prepared to provide care for lesbian or bisexual patients was associated with attending a university-based program, working in a hospital without religious affiliation, and year of training. Feeling prepared to provide healthcare for transgender patients correlated with grand rounds focused on LGBTQ health and supervised clinical involvement. Regarding training, 62% and 63% of participants stated their programs dedicate 1-5 h per year to lesbian/bisexual healthcare and transgender healthcare training, respectively. Concurrently, 92% desired more education on how to provide healthcare to LGBTQ patients. Perceived barriers to receiving training in LGBTQ healthcare included curricular crowding (85%) and lack of experienced faculty (91%). CONCLUSION Our assessment indicates Illinois Ob/Gyn residents feel inadequately prepared to address healthcare needs of LGBTQ patients. Although barriers exist, residents desire more education and training in providing healthcare to the LGBTQ community. Future work is needed to address this gap through curricular development to ensure that Ob/Gyn residency graduates are prepared care for LGBTQ patients.
Collapse
Affiliation(s)
- Karla Daniela Guerrero-Hall
- Department of Obstetrics and Gynecology, The University of Chicago, 5841 South Maryland Avenue MC 2050, Chicago, IL 60637 USA
| | - Rebecca Muscanell
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, VT USA
| | - Namrata Garg
- The University of Chicago Pritzker School of Medicine, Chicago, IL USA
| | - Iris L. Romero
- Department of Obstetrics and Gynecology, The University of Chicago, 5841 South Maryland Avenue MC 2050, Chicago, IL 60637 USA
| | - Julie Chor
- Department of Obstetrics and Gynecology, The University of Chicago, 5841 South Maryland Avenue MC 2050, Chicago, IL 60637 USA
| |
Collapse
|
43
|
Hsieh N, Mirzoyan I. Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation. LGBT Health 2021; 8:222-230. [PMID: 33689403 DOI: 10.1089/lgbt.2020.0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Prior studies have identified health care providers' lack of cultural competency as a major barrier to care among sexual minority individuals. However, little is known about disparities in experience with culturally competent care by sexual orientation at the population level. This study assessed experiences with culturally competent care and satisfaction with care across sexual orientation groups in the United States. Methods: We analyzed nationally representative data from the 2017 National Health Interview Survey (n = 21,620) with ordinal logit regression models and compared six aspects of health care experiences across sexual orientation groups. These were: preferences for and frequencies of seeing health care providers who understand or share their culture; perceived experiences of being treated with respect by providers and providers asking about their beliefs and opinions; access to easily understood health information from providers; and satisfaction with received care. Results: Relative to heterosexual men, gay men were more likely to consider it important for providers to understand or share their culture (odds ratio [OR] = 1.4, p < 0.05) and to have providers who ask for their opinions or beliefs about care (OR = 1.5, p < 0.01). Relative to heterosexual women, bisexual- and something else-identified women were less likely to report being treated with respect (ORs = 0.4-0.6, p's < 0.01) and satisfaction with care (ORs = 0.5-0.6, p's < 0.05). No statistical differences in health care experiences were found between other sexual minority groups and their heterosexual counterparts. Conclusions: Access to culturally competent care and satisfaction with care varied by sexual orientation and gender. Clinical practices should address the unique health care barriers faced by bisexual- and something else-identified women.
Collapse
Affiliation(s)
- Ning Hsieh
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Inna Mirzoyan
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| |
Collapse
|
44
|
Colson PW, Franks J, Wu Y, Winterhalter FS, Knox J, Ortega H, El-Sadr WM, Hirsch-Moverman Y. Adherence to Pre-exposure Prophylaxis in Black Men Who Have Sex with Men and Transgender Women in a Community Setting in Harlem, NY. AIDS Behav 2020; 24:3436-3455. [PMID: 32385678 DOI: 10.1007/s10461-020-02901-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While oral pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention, consistent use is necessary to achieve its intended impact. We compared effectiveness of enhanced PrEP (enPrEP) adherence support to standard of care (sPrEP) among Black MSM and TGW attending a community clinic in Harlem, NY. EnPrEP included peer navigation, in-person/online support groups, and SMS messages. Self-reported adherence over previous 30 days, collected in quarterly interviews, was defined as ≥ 57%. Crude and adjusted analyses examined factors associated with adherence. A total of 204 participants were enrolled and randomized; 35% were lost to follow-up. PrEP adherence was 30% at 12-months; no intervention effect was observed (p = 0.69). Multivariable regression analysis found that lower adherence was associated with low education and depressive symptoms. We found that an enhanced adherence intervention did not improve PrEP adherence. Findings point to the need for innovative methods to improve PrEP adherence among Black MSM and TGW.Clinical Trial Registration NCT02167386, June 19, 2014.
Collapse
|
45
|
Rowniak S, Bolt L, Sharifi C. Effect of cross-sex hormones on the quality of life, depression and anxiety of transgender individuals: a quantitative systematic review. ACTA ACUST UNITED AC 2020; 17:1826-1854. [PMID: 31021971 DOI: 10.11124/jbisrir-2017-003869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals. INTRODUCTION Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic. INCLUSION CRITERIA Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety. METHODS A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools. RESULTS Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred. CONCLUSIONS Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.
Collapse
Affiliation(s)
- Stefan Rowniak
- School of Nursing and Health Professionals, University of San Francisco, San Francisco, USA
| | - Lindsay Bolt
- Institute for Nursing Excellence, University of California, San Francisco (UCSF) Health, San Francisco, USA.,UCSF Centre for Evidence Synthesis & Implementation: a Joanna Briggs Institute Centre of Excellence
| | - Claire Sharifi
- University of San Francisco Gleeson Library, Geschke Center, University of San Francisco, San Francisco, USA
| |
Collapse
|
46
|
Abstract
We describe barriers to clinical care and research participation unique to transgender and gender nonbinary people and offer concrete suggestions for creating more inclusive environments. We aim to make evident that solely referencing cisgender women in the context of sexual and reproductive health—particularly pregnancy planning and care—excludes a diverse group of transgender and gender nonbinary people who have sexual and reproductive health needs and experiences that can be similar to but also unique from those of cisgender women. We call on clinicians and researchers to ensure that all points of sexual and reproductive health access, research, sources of information, and care delivery comprehensively include and are accessible to people of all genders. We describe barriers to sexual and reproductive health care and research participation unique to people of marginalized gender identities, provide examples of harm resulting from these barriers, and offer concrete suggestions for creating inclusive, accurate, and respectful care and research environments—which will lead to higher quality health care and science for people of all genders.
Collapse
|
47
|
Sok S, Hong R, Chhoun P, Chann N, Tuot S, Mun P, Brody C, Yi S. HIV risks and recent HIV testing among transgender women in Cambodia: Findings from a national survey. PLoS One 2020; 15:e0238314. [PMID: 32886693 PMCID: PMC7473569 DOI: 10.1371/journal.pone.0238314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Globally, the prevalence of HIV among transgender women remains much higher than that of the general population, and a large proportion of them are unaware of their HIV status. Transgender women are exposed to gender-based violence and social stigma and discrimination in different settings that may create significant barriers to receiving HIV prevention and care services. This study aimed to identify factors associated with recent HIV testing among transgender women in Cambodia. Methods We conducted a cross-sectional survey in 2016 among 1375 transgender women recruited from 13 provinces using a peer-based social network recruitment method. We used a structured questionnaire for face-to-face interviews and performed rapid HIV/syphilis testing onsite. We used a multiple logistic regression analysis to identify factors associated with recent HIV testing. Results Of the total, 49.2% of the participants reported having an HIV test in the past six months. After controlling for other covariates, the odds of having an HIV test in the past six months was significantly lower among students (AOR 0.36, 95% CI 0.20–0.65), participants who perceived that they were unlikely to be HIV infected (AOR 0.50, 95% CI 0.32–0.78), and participants who reported always using condoms with male non-commercial partners in the past three months (AOR 0.65, 95% CI 0.49–0.85) relative to their respective reference group. The odds of having an HIV test in the past six months was significantly higher among participants who had been reached by community-based HIV services (AOR 5.01, 95% CI 3.29–7.65) and received HIV education (AOR 1.65, 95% CI 1.06–2.58) in the past six months relative to their respective reference group. Conclusions Despite the widely available free HIV testing services, more than half of transgender women in this study had not received an HIV test in the past six months. Our findings suggest that a tailored and comprehensive combination prevention program, in which HIV testing is linked to care continuum and beyond, maybe an essential next step. Social media may have the potential to be promoted and utilized among transgender women populations in order to improve HIV testing and other prevention measures.
Collapse
Affiliation(s)
- Say Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Carinne Brody
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, California, United States of America
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- * E-mail:
| |
Collapse
|
48
|
Szél Z, Kiss D, Török Z, Gyarmathy VA. Hungarian Medical Students' Knowledge About and Attitude Toward Homosexual, Bisexual, and Transsexual Individuals. JOURNAL OF HOMOSEXUALITY 2020; 67:1429-1446. [PMID: 31034340 DOI: 10.1080/00918369.2019.1600898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.
Collapse
Affiliation(s)
- Zsuzsanna Szél
- Institute of Behavioural Sciences, Semmelweis University , Budapest, Hungary
| | - Dániel Kiss
- Doctoral School of Psychology, ELTE Eötvös Loránd University , Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University , Budapest, Hungary
| | - Zsófia Török
- Department of Public Health, Semmelweis University , Budapest, Hungary
| | - V Anna Gyarmathy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA
- Károly Rácz School of PhD Studies, Semmelweis University , Budapest, Hungary
| |
Collapse
|
49
|
Porsch L, Zhang H, Paschen-Wolff M, Grosskopf N, Grov C. Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011-2017 National Survey of Family Growth. LGBT Health 2020; 7:321-331. [PMID: 32808867 DOI: 10.1089/lgbt.2020.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Methods: Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Results: Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Conclusion: Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.
Collapse
Affiliation(s)
- Lauren Porsch
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hongbin Zhang
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Margaret Paschen-Wolff
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, USA
| | - Nicholas Grosskopf
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| |
Collapse
|
50
|
Decker MJ, Gutmann-Gonzalez A, Price M, Romero J, Sheoran B, Yarger J. Evaluating the Effectiveness of an Intervention Integrating Technology and In-Person Sexual Health Education for Adolescents (In the Know): Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18060. [PMID: 32763885 PMCID: PMC7442936 DOI: 10.2196/18060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background Access to a smartphone is nearly universal among American adolescents, and most of them have used the internet to seek health information. Integrating digital technologies into health program delivery may expand opportunities for youth to receive important health information, yet there are few rigorous studies assessing the effectiveness of this type of intervention. Objective The purpose of this study is to assess the effectiveness of In the Know (ITK), a program integrating in-person and technology-based sexual health education for underserved adolescents. Methods Youth were engaged in the development of the intervention, including the design of the digital technology and the curriculum content. The intervention focuses on 3 main areas: sexual health and contraceptive use, healthy relationships, and educational and career success. It includes an in-person, classroom component, along with a web-based component to complement and reinforce key content. A cluster randomized controlled trial is in progress among adolescents aged 13-19 years living in Fresno County, California. It is designed to examine the differences in self-reported health and behavioral outcomes among youth in the intervention and control groups at 3 and 9 months. Primary outcomes are condom and contraceptive use or no sex in the past 3 months and use of any clinical health services in the past 3 months. Secondary outcomes include the number of sexual partners in the past 3 months and knowledge of local clinical sexual health services. We will use mixed-effects linear and logistic regression models to assess differences between the intervention and control groups. Results Trial enrollment began in October 2017 and ended in March 2020 with a total of 1260 participants. The mean age of the participants is 15.73 (SD 1.83) years, and 69.98% (867/1239) of the participants report being Hispanic or Latino. Study results will be available in 2021. Conclusions ITK has the potential to improve contraceptive and clinic use among underserved youth. This trial will inform future youth-focused health interventions that are considering incorporating technology. International Registered Report Identifier (IRRID) DERR1-10.2196/18060
Collapse
Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Abigail Gutmann-Gonzalez
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Melisa Price
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Julio Romero
- Fresno Economic Opportunities Commission, Fresno, CA, United States
| | | | - Jennifer Yarger
- Philip R Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|