Promoting Cultural Humility: LGBTQIA+ Education for Healthcare Providers

Abstract: Purpose: LGBTQIA+ patients experience devastating mental health and substance abuse disparities. While our organization has a broad non-discrimination statement that includes gender identity and sexual orientation, there is no guidance for how to best serve these patients. Evidence suggests training sessions are a successful means of increasing LGBTQIA+ cultural competency, with “Safe Zone” identified as being especially successful on college campuses. The Healthcare Equality Index also calls for education to demonstrate healthcare organizations’ commitment to LGBTQIA+ patients. Intervention: We developed an educational workshop - Safe Zone – with university psychologists. This workshop included interactive exercises that focused on increasing empathy and cultural humility. Implementation: A formal pilot was completed with inpatient psychiatric nurses. Results demonstrated increased comfort interacting with and advocating for LGBTQIA+ patients, as well as increased knowledge of health disparities and terminology. The workshop, along with pre-and post-education survey data, was presented to key stakeholders in the organization. Outcomes: Safe Zone is now in the early stages of dissemination across the organization. This will give all staff the opportunity to increase their knowledge of LGBTQIA+ patients. We are consulting on clinical information changes happening within our organization. These include creating specific education bulletins to assist staff with asking patients about their LGBTQIA+ identity. Future Implications: We will examine if and how Safe Zone improves experiences for LGBTQIA+ patients. Safe Zone will inspire staff to advocate for their organization to be more inclusive of LGBTQIA+ patients. Education is one aspect of the Healthcare Equality Index, but also a critical step to creating an equitable LGBTQIA+ environment

Addressing Lapses in Medical Education in Relation to LGBTQIA+ Healthcare Disparities

As the LGBT community gains more visibility and acceptance, the individuals identifying as LGBTQIA+ have been increasing. Unfortunately for this community, healthcare disparities for LGBT individuals continue. In fact in a national online survey done with LGBTQIA+ physicians, 65% had heard discriminatory comments made towards LGBTQIA+ patients, and 34% witnessed discriminatory care given to LGBTQIA+ patients. (Bonvinci) Rose Chapman, a senior lecturer at Curtin University Nursing School, contributed this discomfort that medical professionals seem to have with LGBTQIA+ families with socioeconomic background such as religious beliefs or familiarity with the topic. (Chapman) Nevertheless, another study published by the Medical Journal “Family Medicine”, credits that this discomfort Medical Professionals have with LGBTQIA+ patients can be combated strongly with increased clinical exposure and awareness. (Sanchez) This is where medical education becomes crucial to the care and development of the LGBTQIA+ Community. With exposure and experience comes the competence to treat patients. By increasing medical education to encompass the LGBTQIA+ Community, we consequently create better access towards these patients.However, in 2011, over 33% of current US medical schools reported no integration of LGBTQIA+ healthcare in their medical curriculums. And of the schools that did claim competence in this community, they reported a national median of an inadequate 5 hours devoted to LGBTQIA+ related healthcare over a 4 years curriculum. (Bovinci) While it is notably more than in 1991 with over 50% of schools reporting no LGBTQIA+ healthcare, it stops short of what progress this insufficient increase to exposure over the last two decades entails. (Bonvinci) There are currently few studies, if any, addressing the specific areas of LGBTQIA+ healthcare included in medical education, or the success of this inclusion on medical students competence and knowledge.This project addressed these gaps by asking medical students about LGBTQIA+ healthcare specifics; it is novel because it included specific understanding of topics such as the use of Preventative Exposure Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP), and others such as transition assistance for trans patients, HRT, and other topics as well. We surveyed primarily current medical students and determined their understanding of healthcare needs for LGBTQIA+ patients based on their current medical education. We then used this data to analyze strengths and weaknesses of LGBT healthcare in medical education. With this information we can now target specific areas of LGBTQIA+ healthcare disparities, and integrate these more into medical education and medical school curricula. From here, we can also look into the value this will play for public health disparities across communities

Assessment of the Opinions and Attitudes of Medical Students Towards Lgbtqia+ Individuals

DergiPark: 762678tmsjAims: The aim of this multicentral study is to analyze the opinions and attitudes of medical students towards lesbian, gay, bi- sexual, transgender, queer, intersex, and asexual individuals. Methods: A total of 1116 medical students from 59 universities in Turkey, 1 from Bosnia and Herzegovina, and 7 universities from Germany have participated in this study. The questionnaire consisted of 23 multiple-choice questions and an open-ended question. Data about the comparison of 1st and 6th year medical students were analyzed using the Pearson Chi-Squared test and the Fisher Exact test in IBM SPSS version 23.0.00. Results: The mean age of the participants was 21.2 ± 2.1 years (range: 17-34 years). There were 693 female, 417 male, 3 nonbinary, and 1 qu- eer participants, and two did not declare their gender. There were 263 (23.6%) 1st year, 315 (28.3%) 2nd year, 179 (16.0%) 3rd year, 112 (10.0%) 4th year, 98 (8.8%) 5th year, and 139 (12.5%) 6th year students. There were 10 (0.9%) missing data. In the 15th question asking whether LGBTQIA+ individuals have the right to adoption or not, the 18th question asking if their school is providing education on sexual health, the 19th question asking if they consider themselves educated about safe sexual intercour- se as an individual, and the 22nd question asking if they think that LGBTQIA+ individuals are more prone to catching sexually transmitted diseases, there were a significant difference between 1st graders and 6th graders. Conclusion: PIn conclusion, thou- gh the majority of answers given indicate a positive approach towards LGBTQIA+ individuals, it can be stated that the attitude of medical students towards LGBTQIA+ individuals is by far suboptimal

Creating A Welcoming, Inclusive, And Affirming Primary Care Environment For Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex And Asexual Patients

The LGBTQIA+ community has long faced disparities in healthcare which have had significant consequences including increased cancer risk factors and poorer health outcomes when compared to the cisgender, heterosexual community. Interventions are needed to increase the knowledge and cultural competency of providers, to create welcoming and safe spaces for LGBTQIA+ patients, and to encourage disclosure of sexual orientation and gender identity (SOGI). The purpose of this DNP project was to adapt, implement, and evaluate an evidence-based model for creating an affirming, inclusive, culturally competent, and safe primary care environment for LGBTQIA+ patients within a family practice center. This quality improvement project involved care protocol adjustments including modifications to clinic physical/digital infrastructure, revised intake procedures and documentation, and provider/staff trainings. Evaluation included pre-implementation chart review, staff self-efficacy and implementation outcome surveys, and post-intervention demographic assessment of intake forms. Analysis included paired t-tests for comparison of survey responses, and descriptive statistics and chi square analysis for patient intake form responses. Results suggest that a majority of staff were supportive of the interventions, and overall showed improved self-efficacy. A majority of patients engaged well with the new intake protocol, willingly disclosing SOGI information and providing valuable information not previously known or documented. By adapting a multimodal model for implementation in a family practice setting, this project offers a roadmap for any practice to create a welcoming and safe healthcare environment for LGBTQIA+ patients. Through consistent, positive, and affirming engagement with this population, these healthcare disparities can be addressed in concrete and meaningful ways

Insight into Student Perceptions of LGBTQIA+ Content Inclusion in BSN Education

Previous research has indicated that LGBTQIA+ clients continue to receive discriminatory care from healthcare professionals. Undergraduate nursing students (n = 24) completed a survey inquiring about their perceptions of knowledge of this vulnerable population, their preparedness to provide care, and the education they received from their BSN program. Twenty-two students’ responses, 91.67%, indicate a need for further education on the provision of care to LGBTQIA+ patients. These students demonstrated discrepancies in their perceptions and the application of their knowledge. As such, nursing programs should begin to consider providing more thorough education on this vulnerable population to prepare student nurses with practical skills to provide competent care to address care deficits affecting this community

Understanding the State of LGBTQIA+ Healthcare and Support in Camden County

4.5% of American adults identify as lesbian, gay, or bisexual and about 1.4 million adults identify as transgender. This demographic is impacted by many social determinants of health and health disparities, particularly for transgender patients. 33% of LGBTQIA+ patients ranging from a pool of 28,000 surveyed patients have had a negative experience with their health providers, and 8% of them had to educate their physicians about their needs due to physicians’ lack of knowledge about this demographic. Research suggests that there is a reluctance to access mental health services in the LGBTQIA+ community due to homophobia,, difficulties disclosing sexual and gender identity, and fears of being misunderstood

Promoting Health Care Access for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual (LGBTQIA+) Farmworkers

This issue brief discusses the unique challenges faced by LGBTQIA+ farmworkers and the importance of health centers recognizing and addressing these challenges in order to provide high-quality care.There is a common misconception that few or no lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) people exist within the farmworker community. As a result, the health care needs of LGBTQIA+ farmworkers are often overlooked. It is important for health centers to recognize and address the unique challenges faced by LGBTQIA+ farmworkers in order to provide high-quality care to this marginalized population

Patient perceptions in receiving LGBTQIA culturally competent health care

Background: There is a large amount of documented evidence demonstrating that health care providers are caring for diverse populations. This warrants a level of cultural competence (CC) when making health care decisions. Traditionally, Race and ethnicity have been the focus in CC. However, criteria such as sexual orientation and gender identity are often forgotten, or left out altogether. Because of this, patients whose sexual orientation or gender is a minority, may often receive inadequate treatment. This is in part due to the health care providers lack knowledge in this type of CC or present sexual prejudices. Because of this, research is needed to investigate the perceptions of patients that identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, ally (LGBTQIA) when receiving health care.Methods: Cross-sectional design consisting of 140 participants (male=78, female=50, transgender=5, other=7; heterosexual=16, gay/lesbian=72, bisexual=43, other=9, mean age=26.97 ± 7.67). Participants were recruited using a snowball sampling method via email and list-serves. A modified version of the Gay Affirmative Practice (GAP) (reliability a = 0.962), was delivered online to participants to determine need of LGBTQIA cultural competent treatment by health care providers. Means and standard deviations were calculated for each variable (gender, sexual orientation), as well as an overall GAP score (out of 150). Two, single one-way ANOVAs (gender and sexual orientation) were performed with GAP score as the dependent variable.Results: Calculated GAP scores: All=128.82 ± 18.48, male=128.49 ± 15.60, female=130.35 ± 17.10, transgender=129.80 ± 9.31, other=143. 57, heterosexual=129.33 ± 17.12, gay or lesbian=128.25 ± 15.85, bisexual/omni/pansexual/queer/non-monosexual=132.79 ± 14.99, other=131.38 ± 20.37. ANOVA results were modified with Kruskal-Wallis adjustments due to violation of normality and homogeneity of variance, and now are represented by Chi Squares. Gender was the single significant outcome, (X2(3) =8.01, p <0.05). Post hoc testing of gender demonstrated statistical significant in comparing males vs. other.Conclusions: Patients do find it necessary for health care providers to have specific training and/or knowledge in LGBTQIA CC. A majority of results demonstrate strongly agree that health care providers need better CC in LGBTQIA. In comparison of GAP scores in gender, the category of other demonstrates a great need for CC in LGBTQIA in health care providers. Males demonstrated a much lower score, indicating a low priority for LGBTQIA CC in health care. With an increasing LGBTQIA patient population, patients feel the ever increasing need for health care providers to provide knowledgeable, competent, and fair treatment/care

LGBTQIA+ Care Simulation: Examining Participating Students’ Attitude and Comfort

Background: The LGBTQIA+ communities face healthcare disparities that contribute to reduced overall health. One factor affecting LGBTQIA+ communities’ reduced overall health is poor health-promoting behaviors or avoidance of care due to healthcare providers’ lack of knowledge, poor attitude, and low comfort levels with LGBTQIA+ care. There are limited studies to date that address nursing students’ attitude and comfort with LGBTQIA+ affirming care interventions outside of lectures. Therefore, the purpose of this study was to evaluate the effect of a simulation intervention on the attitude and comfort of prelicensure nursing students towards providing care to members of the LGBTQIA+ community. Sample: Study sample was comprised of a convenience sample of pre-licensure nursing students (n = 40) enrolled in a Community Health Nursing didactic course. Method: This study utilized a pre-test post-test design in which the participants rated their attitude and comfort towards LGBTQIA+ care before and after a simulation experience utilizing the Nursing Student’s Knowledge and Attitudes of LGBT Health Concerns (NKALH) survey. Results: There was a statistically significant improvement in participating students’ comfort levels after the simulation intervention. There was no statistically significant improvement in participating students’ attitudes after the simulation intervention. Conclusion: Results showed a significant improvement in participants’ comfort towards providing LGBTQIA+ care after the simulation intervention. While the same intervention did not significantly improve participants’ attitudes towards LGBTQIA+ care, results were trending towards positive. Simulation interventions focusing on LGBTQIA+ care should be integrated into prelicensure nursing curriculum to improve the nursing care of LGBTQIA+ communities

Addressing Bias in LGBTQIA+ Undergraduate Medical Education: An Innovative and Community Based Approach to Curriculum Reform

Background: Individuals who are LGBTQIA+ or gender nonconforming have specific health needs and face health disparities that are exacerbated by a lack of training and cultural sensitivity among health professionals. This study was initiated by a second year University of Massachusetts School of Medicine student in response to the lack of LGBTQIA+ health content in the first year Doctoring & Clinical Skills (DCS1) course. The DCS1 session on collecting a sexual history was selected as the primary focus for revision. Community-Based Participatory Research, because of its emphasis on joining with a community of interest as full and equal partners in all phases of the research process, served as an ideal model for the novel application to curriculum development to address this gap in training in undergraduate medical education. Methods: A sample of 13 LGBTQIA+ community members from Worcester were recruited to form a curriculum advisory committee. The committee convened for two focus-group style meetings where they reviewed the curriculum and had the opportunity to provide their feedback, which was used to rewrite the session. Additionally, the community members had the opportunity to participate in a storytelling video where they discussed their experiences in healthcare as LGBTQIA+ patients. A pre-test post-test design was used to survey the UMMS SOM students in order to evaluate the new version of the DCS1 session. Results: The percentage of M1 students reporting they had the necessary skills to treat LGBTQIA+ patients increased from pre-session to post-session (26.2% (n=130), 63.2% (n=76), p = \u3c 0.001). Compared to current M2 students who completed the course last year (n=65), more MS1 students (n=76) rated the overall quality of the DCS1 session as excellent or good (23.1%, 77.6%, p= \u3c 0.0001. Conclusion: CBPR serves as an efficacious model for the creation of curriculum inclusive of LGBTQIA+ health