提高惩教医疗服务提供者照顾跨性别患者的能力：基于理论的文化和临床能力干预的制定和评估。
Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention.
机构信息
Yale School of Public Health, United States; The Fenway Institute, Fenway Health, United States.
University of California Los Angeles Fielding School of Public Health, United States.
出版信息
Soc Sci Med. 2017 Dec;195:159-169. doi: 10.1016/j.socscimed.2017.10.004. Epub 2017 Oct 30.
RATIONALE
Correctional healthcare providers' limited cultural and clinical competence to care for transgender patients represents a barrier to care for incarcerated transgender individuals.
OBJECTIVE
The present study aimed to adapt, deliver, and evaluate a transgender cultural and clinical competence intervention for correctional healthcare providers.
METHOD
In the summer of 2016, a theoretically-informed, group-based intervention to improve transgender cultural and clinical competence was delivered to 34 correctional healthcare providers in New England. A confidential survey assessed providers' cultural and clinical competence to care for transgender patients, self-efficacy to provide hormone therapy, subjective norms related to transgender care, and willingness to provide gender-affirming care to transgender patients before and after (immediately and 3-months) the intervention. Linear mixed effects regression models were fit to assess change in study outcomes over time. Qualitative exit interviews assessed feasibility and acceptability of the intervention.
RESULTS
Providers' willingness to provide gender-affirming care improved immediately post-intervention (β = 0.38; SE = 0.41, p < 0.001) and from baseline to 3-months post-intervention (β = 0.36; SE = 0.09; p < 0.001; omnibus test of fixed effects χ = 23.21; p < 0.001). On average, transgender cultural competence (χ = 22.49; p < 0.001), medical gender affirmation knowledge (χ = 11.24; p = 0.01), self-efficacy to initiate hormones for transgender women, and subjective norms related to transgender care (χ = 14.69; p = 0.001) all significantly increased over time. Providers found the intervention to be highly acceptable and recommended that the training be scaled-up to other correctional healthcare providers and expanded to custody staff.
CONCLUSION
The intervention increased correctional healthcare providers' cultural and clinical competence, self-efficacy, subjective norms, and willingness to provide gender-affirming care to transgender patients. Continued efforts should be made to train correctional healthcare providers in culturally and clinically competent gender-affirming care in order to improve the health of incarcerated transgender people. Future efficacy testing of this intervention is warranted.
背景
惩教医疗服务提供者在照顾跨性别患者方面的文化和临床能力有限，这是监禁的跨性别者获得护理的障碍。
目的
本研究旨在为惩教医疗服务提供者改编、提供和评估一项跨性别文化和临床能力干预措施。
方法
2016 年夏天，新英格兰的 34 名惩教医疗服务提供者接受了一项基于理论的小组干预措施，以提高他们的跨性别文化和临床能力。一项机密调查评估了提供者照顾跨性别患者的文化和临床能力、提供激素治疗的自我效能感、与跨性别护理相关的主观规范以及向跨性别患者提供性别肯定护理的意愿，分别在干预前后（立即和 3 个月）进行。线性混合效应回归模型用于评估研究结果随时间的变化。定性退出访谈评估了干预措施的可行性和可接受性。
结果
提供者提供性别肯定护理的意愿在干预后立即得到改善（β=0.38；SE=0.41，p<0.001），并且从基线到 3 个月后（β=0.36；SE=0.09；p<0.001；固定效应 χ 检验的总和=23.21；p<0.001）。平均而言，跨性别文化能力（χ=22.49；p<0.001）、医疗性别肯定知识（χ=11.24；p=0.01）、为跨性别女性启动激素治疗的自我效能感以及与跨性别护理相关的主观规范（χ=14.69；p=0.001）均随时间显著增加。提供者认为该干预措施非常可接受，并建议将培训扩展到其他惩教医疗服务提供者，并扩大到拘留工作人员。
结论
该干预措施提高了惩教医疗服务提供者的文化和临床能力、自我效能感、主观规范以及向跨性别患者提供性别肯定护理的意愿。应继续努力培训惩教医疗服务提供者进行文化和临床能力上胜任的性别肯定护理，以改善被监禁的跨性别者的健康状况。有必要对该干预措施进行进一步的疗效测试。
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