TRANSLATE: Transgender and Gender Nonconforming Individuals' Access to Healthcare

NCT03808883 | Completed Results

• 1 other identifier: IRB-2018-2194
• Study Type: interventional
• Target: 49
• Locations: 1 country
• Sites: 1

Brief Summary

Transgender and gender nonconforming (TGNC) individuals face a number of health disparities, many of which can be tied to a lack of access to or use of primary care. Stigma and misunderstanding make simple doctor's visits into ordeals only worth enduring for the most serious of problems. This project addresses those issues by enlisting TGNC people as experts on their own experience. TGNC individuals will form a year-long cohort that will form the basis for this research. Collectively, they will define the scope of challenges faced when seeking healthcare, what medical advocacy training they desire, and how to address groups of healthcare providers and staff. Healthcare providers, including MDs, nurses, and Physicians Assistants (PAs), will attend two facilitated sessions with the TGNC cohort to meet as peers with knowledge exchanged in both directions. Similar meetings will occur with clinic staff, as TGNC individuals have expressed how stigma begins from the moment they call a medical office. Our hypothesis is that when TGNC individuals are given the tools to navigate the healthcare system and the ability to speak with medical professionals as peers, rather than patients, through a participatory action research design they will be better able to access appropriate care through increased confidence and mutual support. The complementary hypothesis for medical providers is that direct interaction with a variety of TGNC individuals who articulate their needs will decrease stigma and increase comfort when treating TGNC people as patients. As a partnership between academic, medical, and community institutions, this project has the potential to directly impact the lives of TGNC individuals who participate and indirectly impact others served by the LGBT Center. This proposal works on three levels: 1) at the academic level - an assessment of participatory action research as an intervention to decrease health disparities, 2) at the individual level - the potential for individuals to increase personal knowledge and skills, and 3) at the institutional level - as actors within the TGNC community develop relationships with individual healthcare providers, medical clinics and activist groups and community partners and educational institutions are concurrently forming networks that will have positive, although probably more diffuse, impact on TGNC individuals as these institutions come together to support TGNC health care.

Conditions

Gender Identity

Keywords

Barriers to Healthcare Access; Participatory Action Research; Cultural Competency

Outcome Measures

Primary Outcomes (7)

• Change in Knowledge of TGNC Individuals of Total Number of Locations to Receive Medical Care in Cleveland Known

  TGNC participants were asked pre and post-intervention to name all the hospitals they knew of where they could received medical care. Mean and range are reported. This measure was unreliable as participants, when asked in the post survey to name locations for healthcare, were not given those they had identified in the pre-intervention survey, so some participants actually decreased the number they named. Additionally, growth from this measure is mean growth of the group, not a mean of the sum of individual's growth.

  Baseline and 11 months

• Change From Baseline in Knowledge of TGNC Cohort About Transgender and Gender Nonconforming Medical Issues

  TGNC Cohort Participants were asked to respond with their agreement with the following statement: "I am knowledgeable about how being transgender or gender non-conforming impacts my health." Response options were 1=Disagree Strongly, 2=Disagree, 3=Neutral, 4=Agree, and 5=Agree Strongly. Change was measured as month 11 minus baseline score, and higher scores represented the better outcome.

  Baseline and 11 months

• Change From Baseline in Knowledge of Healthcare Participants About Transgender and Gender Nonconforming Medical Issues

  Healthcare Participants were asked to respond with their agreement with the following statement: "I know about medical issues that affect transgender and gender nonconforming patients." Response options were 1=Disagree Strongly, 2=Disagree, 3=Neutral, 4=Agree, and 5=Agree Strongly. Because healthcare providers only participated in one facilitated dialogue, baseline was measured prior to the dialogue, and post measures were administered the day after the dialogue. Change was measured as post score- baseline score, and higher scores represented the better outcome.

  Baseline and 24 hours

• Change From Baseline in Attitude of TGNC Individuals Towards Navigating Their Interactions With Healthcare Providers.

  TGNC Individuals were asked to respond with their agreement with the following two statements: 1. "I am able to navigate the healthcare system easily", and 2. "I know how to express my concerns about my health and well-being to healthcare providers." Response options were 1=Disagree Strongly, 2-=Disagree, 3=Neutral, 4=Agree and 5=Strongly agree. For these questions, a higher score indicated confident attitude in handling their healthcare needs. Change from Baseline to 11 months was measured.

  Baseline and 11 months

• Change in Attitude of Medical Providers Towards Transgender Issues.

  Healthcare Participants were asked to respond with their agreement with the following statement: "I am comfortable advocating for transgender and gender non-conforming people's right to access respectful and appropriate health care in the place where I practice." Response Options were 1=Disagree Strongly, 2=Disagree, 3=Neutral, 4=Agree, and 5=Agree Strongly, with a higher score indicating a more positive attitude towards transgender issues. Change was measured by subtracting the providers' responses after participation in a facilitated dialogue with TGNC participants from their scored response prior to participating in the dialogue.

  Baseline and 24 hours.

• Qualitative Shift in Confidence of TGNC Individuals in Seeking Medical Care After the Intervention.

  Percentage of TGNC individuals expressing key themes related to shift of confidence of TGNC Individuals to seek medical care following the intervention.

  Interview at 11 months.

• Qualitative Shift in Confidence of Medical Provider in Providing Culturally Competent Medical Care to TGNC Individuals After the Intervention.

  The number of medical providers expressing themes illustrating a shift in confidence with their ability to provide culturally competent medical care in structured interview following the facilitated dialogue with members of the TGNC participant group.

  Interview within one day following the facilitated dialogue

Study Arms (2)

TGNC Cohort

EXPERIMENTAL

The Translate Study developed a cohort of transgender and gender non-conforming individuals (referred to here as TGNC cohort) and held three facilitated dialogue sessions with healthcare providers and staff (referred to here as healthcare participants). The overall goal of the Translate Study was to improve quality of life by reducing health disparities suffered by transgender and gender nonconforming (TGNC) individuals and by increasing their access to and use of primary health care.

Behavioral: TGNC Directed Advocacy Meetings; Behavioral: Facilitated Dialogues between TGNC Cohort and Healthcare Participants

Healthcare Participants

EXPERIMENTAL

The Translate Study held three facilitated dialogue sessions between the TGNC Cohort and a group of healthcare participants, identified as physicians, nurse practitioners, registered nurses, students, physician assistants, and non-provider staff positions. Non-providers included healthcare administrative positions, rehabilitation, and vocational services.

Behavioral: Facilitated Dialogues between TGNC Cohort and Healthcare Participants

Interventions

TGNC Directed Advocacy Meetings BEHAVIORAL

Series of 18 meetings with TGNC cohort, including 3 facilitated dialogues with the healthcare participants, to articulate barriers to access and to enter into dialogue with medical providers and staff.

TGNC Cohort

Facilitated Dialogues between TGNC Cohort and Healthcare Participants BEHAVIORAL

Healthcare Participants attend a facilitated dialogue with the TGNC cohort. 3 total facilitated dialogues were held, but each healthcare participant attends only 1 session.

Healthcare Participants; TGNC Cohort

Eligibility Criteria

• Age: 14 Years+
• Gender Eligibility Details: TGNC cohort must self-identify as transgender or gender nonconforming
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• self-identify as transgender or gender nonconforming
• fluent English speaker
• above the age of 14 years old

You may not qualify if:

• non-fluent English speaker
• below the age of 14 years old
• does not identify as transgender or gender nonconforming
• Currently employed as a medical provider or medical staff
• At least 18 years old
• fluent English speaker
• Not currently employed as a medical provider or medical staff
• non-fluent English speaker
• below the age of 18 years old

Sponsors & Collaborators

• Case Western Reserve University: lead
• LGBT Community Center of Greater Cleveland: collaborator
• MetroHealth Medical Center: collaborator

Study Sites (1)

LGBT Community Center of Greater Cleveland

Cleveland, Ohio, 44102, United States

Location

Limitations and Caveats

The Translate Study was a pilot study, with a convenience sampling design that limits the findings' generalizability. Sample size and inability to use a validated scale limits the findings' reliability. The surveys were developed before assembling the TGNC cohort so the questions did not always align with their objectives. One healthcare participant complained that the facilitated dialogue with TGNC cohort unnecessarily discussed racism. The Study PI and staff are no longer employed by CWRU.

Results Point of Contact

• Title: Sarah Fulton, MA, RA, Begun Center, Jack, Joseph and Morton Mandel School of Applied Social Science
• Organization: Case Western Reserve University

sarah.fulton@case.edu

216-368-0429

Study Officials

• Daniel J Flannery, PhD

  Director, Begun Center for Violence Prevention Research and Education; Jack, Joseph and Morton Mandel School of Applied Social Sciences

  STUDY CHAIR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 9, 2019
• First Posted: January 18, 2019
• Study Start: February 1, 2019
• Primary Completion: December 10, 2019
• Study Completion: December 10, 2020
• Last Updated: August 14, 2024
• Results First Posted: August 14, 2024

Record last verified: 2024-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)