Gender Affirmation as a Source of Resilience for Addressing Stigmatizing Healthcare Experiences of Transgender Youth of Color

Abstract Background Transgender and other gender diverse (TGD) youth of color experience stigma within healthcare. Gender affirmation can be a resilience resource; however, little is known about gender affirmation within healthcare. Purpose This study explores TGD youth of color’s experiences of stigma and gender affirmation across the entire healthcare experience and their role on motivation to seek care. Methods In 2015, cross-sectional surveys and individual in-depth interviews were conducted among 187 TGD youth ages 16–24 living in 14 U.S. cities. Analyses followed a mixed-methods design whereby 33 participants were purposively selected for a qualitative phenomenological analysis based on quantitatively reported gender affirmation needs. Subsequent quantitative analyses examined how healthcare use differed by access to gender affirmation. Results Participants qualitatively described experiencing stigma across multiple healthcare settings (e.g., primary care, emergency care, medical gender affirmation), including before (finding providers, scheduling), during (waiting rooms, provider interactions), and after (pharmacy) healthcare visits. Participants who quantitatively reported access to gender-affirming healthcare still described negative healthcare experiences, either because they accessed multiple healthcare services or because of prior negative experiences. Stigma and gender affirmation (both inside and outside of healthcare) influenced motivation to seek care, with variation depending on the type of care. Quantitative analyses confirmed these findings; access to gender affirmation differed for participants who delayed primary care vs. those who did not, but did not vary based on participants’ use of medical gender affirmation. Conclusions Findings highlight the importance of promoting gender-affirming healthcare environments to increase access to care for TGD youth of color.

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Pharmacies in informal settlements: a retrospective, cross-sectional household and health facility survey in four countries

BMC Health Services Research ◽

10.1186/s12913-021-06937-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

◽

Pauline Bakibinga ◽

Caroline Kabaria ◽

Ziraba Kasiira ◽

Peter Kibe ◽

...

Keyword(s):

Primary Care ◽

Urban Poor ◽

Informal Settlements ◽

Healthcare Services ◽

Cross Sectional ◽

Large Cities ◽

Adults And Children ◽

Access To Primary Care ◽

Facility Survey ◽

Almost All

Abstract Background Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a “pharmacy” across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.

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Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00110618 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 3

Author(s):

Sérgio Carrara ◽

Jimena de Garay Hernandez ◽

Anna Paula Uziel ◽

Greice Maria Silva da Conceição ◽

Henri Panjo ◽

...

Keyword(s):

Rio De Janeiro ◽

Healthcare Services ◽

Original Method ◽

Metropolitan Region ◽

Trans Men ◽

Trans People ◽

Gender Affirmation ◽

Body Construction ◽

Gender Based ◽

And Gender

The article examines health itineraries followed by Brazilian travestis, trans men and trans women in the affirmation of their gender, based on the survey Trans Uerj: Health and Citizenship of Trans People in Brazil. The survey’s main objectives were to gauge the trans/travesti population’s diversity and sociodemographic profile; and to map the various ways they access their rights as citizens, especially to healthcare services and body modification technologies. Interviewers, mainly trans people and travestis, applied 391 questionnaires in the city of Rio de Janeiro and its metropolitan region to interviewees of different social classes, schooling levels and gender identity configurations, contacted through the interviewers’ social networks. For defining respondents’ gender identities the survey used an original method based on self-definitions, which were then aggregated into 6 categories for data analysis purposes. This article discusses the multiple strategies used by this trans population in gender affirmation processes to gain access to regulated and/or unregulated use of hormones and surgical procedures.

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Living conditions, HIV and gender affirmation care pathways of transgender people living with HIV in France: a nationwide, comprehensive, cross-sectional, community-based research protocol (ANRS Trans&HIV)

BMJ Open ◽

10.1136/bmjopen-2021-052691 ◽

2021 ◽

Vol 11 (12) ◽

pp. e052691

Author(s):

Marion Mora ◽

Giovanna Rincon ◽

Michel Bourrelly ◽

Gwenaëlle Maradan ◽

Anaenza Freire Maresca ◽

...

Keyword(s):

Medical Care ◽

Living Conditions ◽

Hiv Care ◽

Care Pathways ◽

Community Based ◽

Cross Sectional ◽

Transgender People ◽

Community Based Research ◽

Gender Affirmation ◽

And Gender

IntroductionTransgender identity is poorly accepted in France, and data on living conditions and the daily difficulties transgender people encounter are scarce. This lack of data reinforces their invisibility in social life, contributes to their stigmatisation and probably increases the burden of HIV infection, especially for HIV-positive transgender people (TRHIV). The main objective of the community-based research study ANRS Trans&HIV is to identify personal and social situations of vulnerability in TRHIV, the obstacles they encounter in terms of access to and retention in medical care, and their gender affirmation and HIV care needs.Methods and analysisANRS Trans&HIV is a national, comprehensive, cross-sectional survey of all TRHIV currently being followed in HIV care units in France. TRHIV women are exclusively included in the quantitative component, and TRHIV men in the qualitative component. Data are collected by community-based interviewers and will be analysed to explore patient care pathways and living conditions in the TRHIV population with regard to gender affirmation and HIV. Data collection began in October 2020 and should be completed in December 2021. The statistical analyses techniques used will be adapted to each of the study’s objectives and to the type of data collected (cross-sectional (questionnaires) and retrospective (biographical trajectory)). The study’s results will provide a greater understanding of TRHIV health needs in order to suggest possible national recommendations for comprehensive HIV and gender affirmation medical care.Ethics and disseminationANRS Trans&HIV was approved by Inserm’s Ethical Evaluation Committee (no 20-694 on 12 May 2020) and is registered with the National Commission on Informatics and Liberty under number 2518030720. Potential participants are informed about the study through an information note provided by their attending HIV physician. All results published in peer-reviewed journals will be disseminated to the HIV transgender community, institutional stakeholders and healthcare providers.Trial registration numberNCT04849767.

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A cross-sectional study of Swiss ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model

10.21203/rs.2.22183/v3 ◽

2020 ◽

Author(s):

Mia Messi ◽

Yolanda Mueller ◽

Dagmar M. Haller ◽

Andreas Zeller ◽

Stefan Neuner-Jehle ◽

...

Keyword(s):

Primary Care ◽

Health Services ◽

Healthcare Services ◽

Cross Sectional Study ◽

Healthcare Use ◽

Enabling Factors ◽

Cross Sectional ◽

Andersen Model ◽

Multimorbid Patients ◽

Services Use

Abstract Background: Multimorbidity is frequently encountered in primary care and is associated with increasing use of healthcare services. The Andersen Behavioral Model of Health Services Use is a multilevel framework classifying societal, contextual, and individual characteristics about the use of healthcare services into three categories: 1. predisposing factors, 2. enabling factors, and 3. need factors. The present study aimed to explore multimorbid patients' use of ambulatory healthcare in terms of homecare and other allied health services, visits to GPs, and number of specialists involved. A secondary aim was to apply Andersen's model to explore factors associated with this use. Method: In a cross-sectional study, 100 Swiss GPs enrolled up to 10 multimorbid patients each. After descriptive analyses, we tested the associations of each determinant and outcome variable of healthcare use, according to the Andersen model: predisposing factors (patient's demographics), enabling factors (health literacy (HLS-EU-Q6), deprivation (DipCare)), and need factors (patient's quality of life (EQ-5D-3L), treatment burden (TBQ), severity index (CIRS), number of chronic conditions, and of medications). Logistic regressions (dichotomous variables) and negative binomial regressions (count variables) were calculated to identify predictors of multimorbid patients' healthcare use.Results: Analyses included 843 multimorbid patients; mean age 73.0 (SD 12.0), 28–98 years old; 48.3% men; 15.1% (127/843) used homecare. Social deprivation (OR 0.75, 95%CI 0.62–0.89) and absence of an informal caregiver (OR 0.50, 95%CI 0.28–0.88) were related to less homecare services use. The use of other allied health services (34.9% (294/843)) was associated with experiencing pain (OR 2.49, 95%CI 1.59–3.90). The number of contacts with a GP (median 11 (IQR 7-16)) was, among other factors, related to the absence of an informal caregiver (IRR 0.90, 95%CI 0.83–0.98). The number of specialists involved (mean 1.9 (SD 1.4)) was linked to the treatment burden (IRR 1.06, 95%CI 1.02–1.10).Conclusion: Multimorbid patients in primary care reported high use of ambulatory healthcare services variably associated with the Andersen model's factors: healthcare use was associated with objective medical needs but also with contextual or individual predisposing or enabling factors. These findings emphasize the importance of adapting care coordination to individual patient profiles.

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A cross-sectional study of Swiss ambulatory care services use by multimorbid patients in primary care in the light of the Andersen model

10.21203/rs.2.22183/v2 ◽

2020 ◽

Author(s):

Mia Messi ◽

Yolanda Mueller ◽

Dagmar M. Haller ◽

Andreas Zeller ◽

Stefan Neuner-Jehle ◽

...

Keyword(s):

Primary Care ◽

Health Services ◽

Healthcare Services ◽

Cross Sectional Study ◽

Healthcare Use ◽

Enabling Factors ◽

Cross Sectional ◽

Andersen Model ◽

Multimorbid Patients ◽

Services Use

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Well-being during COVID-19 pandemic: A comparison of individuals with minoritized sexual and gender identities and cis-heterosexual individuals

PLoS ONE ◽

10.1371/journal.pone.0252356 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252356

Author(s):

Pichit Buspavanich ◽

Sonia Lech ◽

Eva Lermer ◽

Mirjam Fischer ◽

Maximilian Berger ◽

...

Keyword(s):

Support Groups ◽

Online Survey ◽

Mental Healthcare ◽

Well Being ◽

Healthcare Services ◽

Vulnerable Groups ◽

Gender Identities ◽

Cross Sectional ◽

Substantial Impact ◽

And Gender

Background Preliminary empirical data indicates a substantial impact of the COVID-19 pandemic on well-being and mental health. Individuals with minoritized sexual and gender identities are at a higher risk of experiencing such negative changes in their well-being. The objective of this study was to compare levels of well-being among cis-heterosexual individuals and individuals with minoritized sexual and gender identities during the COVID-19 pandemic. Methods Using data obtained in a cross-sectional online survey between April 20 to July 20, 2020 (N = 2332), we compared levels of well-being (WHO-5) across subgroups (cis-individuals with minoritized sexual identities, individuals with minoritized gender identities and cis-heterosexual individuals) applying univariate (two-sample t-test) and multivariate analysis (multivariate linear regression). Results Results indicate overall lower levels of well-being as well as lower levels of well-being in minoritized sexual or gender identities compared to cis-heterosexual individuals. Further, multivariate analyses revealed that living in urban communities as well as being in a relationship were positively associated with higher levels of well-being. Furthermore, a moderation analysis showed that being in a relationship reduces the difference between groups in terms of well-being. Conclusion Access to mental healthcare for individuals with minoritized sexual and gender identities as well as access to gender-affirming resources should be strengthened during COVID-19 pandemic. Healthcare services with low barriers of access such as telehealth and online peer support groups should be made available, especially for vulnerable groups.

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Perceptions on the Implementation of Accreditation Requirements and Standards in the Primary Healthcare Centres, Ras Al Khaimah, UAE

Journal of Health Management ◽

10.1177/09720634211035245 ◽

2021 ◽

pp. 097206342110352

Author(s):

Salhah Taresh Ahmed Ali Al Seraidi ◽

Shukri Adam ◽

Pooja Shivappa

Keyword(s):

Quality Of Care ◽

Demographic Data ◽

Healthcare Setting ◽

Healthcare Services ◽

Demographic Variables ◽

Cross Sectional ◽

Level Of Education ◽

Nurses Perceptions ◽

And Gender

The purpose of this study was to assess the changes resulting from the implementation of an accreditation programme on quality of care. This study aims to find the association between nurses’ perceptions of the implementation of accreditation requirements and standards in the healthcare services at primary health centres (PHCs) with selected demographic variables (age, gender, nationality, level of education and designation). A cross-sectional quantitative study was conducted by a self-administered questionnaire. The study sample ( n = 130) nurses who were working in accredited governmental PHCs and the research was conducted in eight PHCs out of the 18 PHCs in Ras Al Khaimah (RAK), UAE. The association between nurses’ perceptions on the implementation of accreditation requirements and standards in the healthcare services in PHCs with selected demographic variables: gender X2 (2. N = 130) = 0.28, p > 0.05, age X2 (1. N = 130) = 1.76, p > 0.05, level of education X2 (6. N = 130) = 0.94, p < .05, designation X2 (4. N = 130) = 13.3, p < .05. Level of education and designation demonstrates the same perception levels (60% moderate and 40% high). There is a significant association between nurses perception of the implementation of JCI accreditation requirement and standard in health serive of PHC’s with the selected demographic data age and designation (p < 0.05). However level of education and gender are not significant(p > 0.05). Nurses are the backbone of any healthcare setting, and they spend more time with the patient. Being a part of the quality of care and patient safety is essential.

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Hormone use and gender afirmation surgeries among transgender population in Vietnam

Journal of Health and Development Studies ◽

10.38148/jhds.0404skpt20-040 ◽

2020 ◽

Vol 04 (04) ◽

pp. 18-31

Author(s):

Nguyen Ha Pham ◽

Van Luyen Nguyen ◽

Van Anh Pham ◽

Thi Bich Ngoc Do ◽

Thi Loi Nguyen ◽

...

Keyword(s):

Unknown Origin ◽

Cross Sectional ◽

Transgender People ◽

Surgical Interventions ◽

Post Surgery ◽

Quality Health ◽

Gender Affirmation ◽

Hormone Use ◽

And Gender ◽

Study Participants

Objective: To describe the current situation of hormone use and surgical interventions of transgender population in some provinces and cities in Vietnam. Research methodology: Cross-sectional descriptive study, combining quantitative and qualitative. Quantitative data was collected by direct interviews using questionnaires with 141 transgender people and qualitative data was collected through 12 in-depth interviews. The study was carried out in Ha Noi, Ho Chi Minh City, Nghe An and Da Nang, from June to October 2019. Results: All 141 study participants have used hormones (100%) and 32 had gender affirmation surgeries (23.4%). More than 73% bought hormones from existing users and use hormones with “mouth to mouth” advice. Among the transgender people who had surgeries, 25% did not have pre-surgery medical checks ups and consultations and 25% had improper check-ups, 50% did not have good care after surgeries and 25% had improper care. Three themes have been identified: 1) Buying "floating" hormones of unknown origin and using them in "mouth to mouth" ways; 2) The painful and risky journey of surgery and 3) A difficult life and uncertain future. Conclusion: Most study participants bought hormones and used them without professional guidance. Insufficient pre-and post-surgery examination, counselling and care. Many bad consequences may arise. Law on Gender Affirmation will help transgender people access safe and quality health services. Keywords: Transgender; Gender affirmation; Hormonal therapy; Transgender surgery; Transsexual law

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Satisfaction Affecting Factors of Mohalla Clinic Services in the Times of COVID -19 Pandemic: A Cross-Sectional Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i36b31967 ◽

2021 ◽

pp. 187-194

Author(s):

Akshay Parmar ◽

Ankit Singh ◽

Sammita Jadhav

Keyword(s):

Primary Care ◽

Online Survey ◽

Healthcare Services ◽

Cross Sectional Study ◽

Affecting Factors ◽

Sectional Study ◽

Primary Care System ◽

Cross Sectional ◽

Validated Questionnaire ◽

The Times

The Delhi government has launched the Mohalla clinic concept in the year 2015 to make health universal and strengthen the primary care system of Delhi. The basic aim was to provide primary care to people located in remote and poor areas of Delhi. This study was conducted from April 2020 to July 2020 to determine the community dwellers' perception and satisfaction level towards Mohalla clinics and their role in the situation of the COVID-19 pandemic. An online survey was conducted with pretested and validated questionnaire. The questionnaire consisted of 28 items, which were identified with the help of a literature review. The responses were collected from 100 respondents selectively from the ones who have availed the Mohalla clinic's service. The analysis of the results revealed that the perception of the community toward the Mohalla clinic is positive. Moreover, out of all the identified factors impacting satisfaction, the availability factor, which includes the availability of doctors and medicines, had the highest influence on the perception of satisfaction from Mohalla Clinics. Additionally, 58 % of the current users have shown willingness to utilize the Mohalla clinic services, even in the times of COVID-19. This is an important finding. It postulates that the Delhi government should focus on the availability of medicines and medical staff to improve satisfaction and render healthcare services in COVID-19.

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Assessment of public oral healthcare services in Curitiba, Brazil: a cross-sectional study using the Primary Care Assessment Tool (PCATool)

BMJ Open ◽

10.1136/bmjopen-2018-023283 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023283 ◽

Cited By ~ 2

Author(s):

Antonio Carlos Nascimento ◽

Simone Tetü Moysés ◽

Renata Iani Werneck ◽

Marilisa Carneiro Leão Gabardo ◽

Samuel Jorge Moysés

Keyword(s):

Primary Care ◽

Oral Health ◽

Assessment Tool ◽

Healthcare Services ◽

Secondary Outcome ◽

Cross Sectional ◽

Care Services ◽

Primary Care Services ◽

Care Assessment ◽

Primary Care Assessment Tool

ObjectivesTo compare two different models of public oral health in primary care services, a so-called family health strategy (FHS), as opposed to non-FHS services designated as ‘conventional’ healthcare (CHC), regarding the presence and extent of the attributes of ‘good’ primary healthcare (PHC). The null hypothesis of this study is that the attributes do not differ between the FHS and CHC.DesignCross-sectional.SettingPublic PHC services in Curitiba, the state capital of Paraná.ParticipantsPHC users of the public oral health network (n=900) and dentists active in this municipal network (n=203).Primary and secondary outcome measuresThe Primary Care Assessment Tool (PCATool)-Dentists and PCATool-Users were used to analyse the primary outcomes (‘essential’ attributes) and secondary outcomes (‘derived’ attributes) in the PHC.ResultsOverall, the primary care services in oral health were well evaluated, both by users and by dentists, with mean scores ascribed to PHC attributes mostly above the cut-off point (6.6). The exception for users were affiliation (6.36; 95% CI 6.11 to 6.60) and accessibility (5.83; 95% CI 5.78 to 5.89); and for dentists the accessibility (5.80; 95% CI 5.63 to 5.96). When comparing FHS and CHC, there was a superiority of the FHS model, which reached a general mean score of 7.53 (95% CI 7.48 to 7.58) among users and 7.56 (95% CI 7.45 to 7.67) among dentists; on the other hand, the CHC general mean score was of 6.61 (95% CI 6.49 to 6.73) and 6.68 (95% CI 6.56 to 6.80) respectively for users and dentists.ConclusionsThe results reveal a reasonable level of attainment of PHC attributes in the services investigated. Nevertheless, public health managers should make efforts to reduce the difficulties faced by users in accessing dental care. The more positive results achieved by FHS services indicate that the provision of oral healthcare under this strategy should be expanded.

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