Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL, 60612, USA.
University of California-Los Angeles, 760 Westwood Plaza A8-159A, Los Angeles, CA, 90095, USA.
Int J Equity Health. 2022 Jul 31;21(1):104. doi: 10.1186/s12939-022-01702-8.
Recent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care; we adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity.
A comparative case method and the EPIS framework were used to examine parallel implementation strategies of transgender community engagement to expand access to care. To foster conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes that led to different interventions to expand access. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders.
Both steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum, and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot an employment program for Black and Latina transgender women.
In Los Angeles and Chicago, transgender community engagement guided implementation processes and led to critical insights regarding specific, local barriers to healthcare. The steering committee itself represented an important vehicle for individual-, organizational-, and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.
最近的行动呼吁要求实施科学关注美国种族、性别和社会不公正交叉点的健康不平等问题。跨性别者，特别是黑人和拉丁裔跨性别女性，经历了一系列的健康不平等和社会不公正。在这项研究中，我们比较了洛杉矶和芝加哥的两种跨性别社区参与实施策略，以解决护理机会不平等的问题；我们对跨性别健康公平的探索规划实施和维持（EPIS）框架进行了调整和扩展。
采用比较案例法和 EPIS 框架，考察了扩大护理机会的跨性别社区参与的平行实施策略。为了促进 EPIS 在跨性别健康公平方面的概念发展和适应，比较案例法要求详细描述、探索和分析导致不同扩大获得护理机会的干预措施的社区参与过程。在这两个城市，分析单位都是由当地跨性别和 cisgender 利益相关者组成的指导委员会。
两个指导委员会都以世界咖啡馆风格的方式启动了他们的探索过程，这是一种跨性别社区参与的活动，旨在评估社区的需求和医疗保健的结构性障碍。指导委员会策划了一些活动，放大了跨性别社区成员在利益相关者中的声音，鼓励更有效地合作推进跨性别健康公平。根据洛杉矶市政厅的分析和发现，指导委员会与当地一所医学院合作，扩展了跨性别医学课程，并纳入了跨性别社区参与的元素。芝加哥指导委员会从他们的研究结果中得出结论，对结构性种族主义和获得医疗保健机会的障碍最具影响力的干预措施将是为黑人和拉丁裔跨性别女性设计和试行一个就业方案。
在洛杉矶和芝加哥，跨性别社区的参与指导了实施过程，并对当地医疗保健的具体障碍有了重要的见解。指导委员会本身是个人、组织和社区层面建立关系和能力建设的一个重要载体。这项比较案例研究强调了 EPIS 的关键适应，以形成跨性别健康公平的实施科学框架。
Zotero 插件
