Development and psychometric properties of the tool for assessing LGBTQI+ health training (TALHT) in pre-licensure nursing curricula

Sherman, Athena D F; Klepper, Meredith; Claxton, Aubrey; Deng, Angie; Ling, Catherine; Mollenkopf, Nicole L.; Bower, Kelly M.

doi:10.1016/j.nedt.2021.105255

Cited by 15 publications

(5 citation statements)

References 29 publications

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“…Future research, practice, and policy should consider primary, secondary, and tertiary prevention approaches to reduce the effects of anti-TGD stigma on mental health outcomes among TGD people. Primary prevention approaches, such as integrating TGD health training into nursing and other health professions curricula, providing continuing TGD health education to practicing clinicians, and advocating for policy change to improve protections for TGD people, are widely needed and several models exist to guide intervention evaluation and implementation efforts ( Chu et al, 2022 ; Hughes et al, 2022 ; Redcay et al, 2021 ; Sherman, Cimino, et al, 2021 ; Sherman, Klepper, et al, 2022 ; Sherman, Smith, et al, 2022 ; Soled et al, 2022 ). Moreover, policy advocates can make recommendations and support policies to expand public health insurance coverage to improve access to care and reduce financial burden for TW and implement policies providing protection in housing, employment, healthcare provision, and public accommodations for all TW ( Clark et al, 2021 ; Redcay et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

Sherman,

Higgins,

Balthazar

et al. 2023

J of Nursing Scholarship

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IntroductionExisting literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co‐occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring.Design/MethodsPartial least square path modeling followed by response‐based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)‐based TW (N = 1418; 46.2% White non‐Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post‐traumatic stress and psychological distress).ResultsThe final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW.ConclusionOur findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co‐occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real‐world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti‐racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts.Clinical RelevanceThis study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post‐traumatic stress disorder and psychological distress. Specifically, interventions should take an anti‐racist approach and would benefit from incorporating social support‐building activities.

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Section: Discussionmentioning

confidence: 99%

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

Sherman,

Higgins,

Balthazar

et al. 2023

J of Nursing Scholarship

Self Cite

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“…Nonetheless, next steps in this area of research could include exploring educator knowledge and preparedness and questions related to strategies for effective implementation of competencies. For example, physiotherapy programs could use the tool for assessing LGBTQI + health training (TAHLT) [ 36 ] as a guide to assess and improve their 2SLGBTQIA + curriculum content, and to help train faculty on incorporating 2SLGBTQIA + care into teaching.…”

Section: Discussionmentioning

confidence: 99%

Students’ attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs

Primeau,

Philpott,

Vader

et al. 2023

BMC Public Health

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Background Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons. Methods We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness. Results We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed (n = 137; 92%), believed training should be mandatory (n = 141; 94%) and were willing to engage in more training (n = 138; 92%). Around half believed their physiotherapy program (n = 80, 54%) and clinical placements (n = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors (n = 69, 46%) and clinical instructors (n = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most (n = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]). Conclusions Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.

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“…Using a validated framework may help facilitate the integration process and lead to better overall student comprehension. For example, the tool for assessing LGBTQI + health training (TAHLT) [ 32 , 82 ], developed to evaluate content in nursing curricula [ 32 , 82 ], could be used to help map and evaluate 2SLGBTQIA+ curriculum content in physiotherapy programs and identify areas for improvement. The TAHLT could also be used to help train faculty on effectively incorporating 2SLGBTQIA+ care into teaching and be used long-term to guide program goals and provide evidence of progression.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey

et al. 2023

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Background Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada. Methods We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no). Results A total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient’s gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0–10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training. Conclusions Entry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.

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Development and psychometric properties of the tool for assessing LGBTQI+ health training (TALHT) in pre-licensure nursing curricula

Cited by 15 publications

References 29 publications

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

Students’ attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs

Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey

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