Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
J Rural Health. 2023 Jan;39(1):251-261. doi: 10.1111/jrh.12683. Epub 2022 May 29.
This study assessed factors affecting the provision of affirming-care best practices (ACBPs) for transgender individuals by primary care providers (PCPs) in a rural, southern state METHODS: We conducted a sequential explanatory mixed-methods study in 2020, including a statewide survey (phase 1) and interviews (phase 2). Surveyed PCPs (phase 1) included Medical Doctors/Doctors of Osteopathy (MDs/DOs), nurse practitioners, and 1 physician assistant. Interview participants (phase 2) included providers and staff in 6 practices throughout the state. We used an exploratory approach to data collection and performed content analysis to classify interview data into categories representing overarching themes RESULTS: Among surveyed PCPs who reported they had provided care to transgender patients (n = 35), the most common reason for providing gender-affirming medical services was "because of my ethical obligation to treat patients equally" (n = 27, 77%). The most common reason for not providing such services was because the PCPs "have not been trained/don't feel competent to provide these services" (n = 12, 34%). Interviews revealed the following themes: (1) willingness to provide "culturally competent care"; (2) continuum of accepting to affirming attitudes toward transgender individuals; (3) basic understanding of stigma and an awareness of its impact; (4) changes needed to provide "culturally competent care"; and (5) preferred clinical support strategies.
Training and education to provide ACBPs are warranted and would meet the needs of patients and providers. Facilitating telemedicine visits for transgender patients with gender-affirming care experts was a favorable implementation strategy for clinical support and is recommended to address access to affirming care.
本研究评估了影响初级保健提供者（PCP）为跨性别者提供肯定护理最佳实践（ACBPs）的因素，该研究在一个南部农村州进行。
我们于 2020 年进行了一项顺序解释性混合方法研究，包括全州范围的调查（第 1 阶段）和访谈（第 2 阶段）。调查的 PCP（第 1 阶段）包括医学博士/骨科医生（MD/DO）、执业护士和 1 名医师助理。访谈参与者（第 2 阶段）包括全州 6 个实践中的提供者和工作人员。我们采用了探索性的数据收集方法，并对访谈数据进行了内容分析，将其分类为代表总体主题的类别。
在报告曾为跨性别患者提供护理的调查 PCP 中（n = 35），提供性别肯定医疗服务的最常见原因是“因为我有平等对待患者的道德义务”（n = 27，77%）。不提供此类服务的最常见原因是因为 PCP“没有接受过培训/觉得没有能力提供这些服务”（n = 12，34%）。访谈揭示了以下主题：（1）愿意提供“文化上胜任的护理”；（2）从接受态度到肯定跨性别者态度的连续体；（3）对耻辱感的基本理解及其影响的认识；（4）提供“文化上胜任的护理”所需的改变；（5）首选的临床支持策略。
提供 ACBPs 的培训和教育是必要的，将满足患者和提供者的需求。为有性别肯定护理需求的跨性别患者提供远程医疗访问是一种有利于实施的临床支持策略，建议采用这种策略来解决获得肯定护理的问题。
