Health Differences Among Lesbian, Gay, and Transgender Veterans by Rural/Small Town and Suburban/Urban Setting

KauthMichael, R; BarreraTerri, L; Nicholas, DentonF.; Latini, David

doi:10.1089/lgbt.2016.0213

Cited by 24 publications

(15 citation statements)

References 39 publications

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“…Age is also a critical variable for trans patients seeking treatment. Given an online survey of 252 respondents (mean age 47.9), rural residing trans and LGBTQ+ US veterans face longer travel times to HCPs than their suburban or urban counterparts ( 21 ). According to the Canada Trans Health Survey, for rural and remote residing trans youth in particular, who comprised 9.3% of the total sample, aged 14 to 25, transportation presents significant obstacles for accessing urban health care ( 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review

et al. 2021

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Research shows an overrepresentation of trans people in vulnerable socioeconomic situations, primarily due to experiences of discrimination. At the same time, rural or suburban living areas often lack specialized trans-related health care, which a majority of trans people rely on to some extent. Taken together, the lack of both socioeconomic resources and access to trans-related health care can exacerbate health-related distress and impairment for trans people. We illustrate this problem using case vignettes of trans people from rural and suburban areas in (Northern) Germany. They are currently participating in an e-health intervention and randomized controlled trial (RCT) called i2TransHealth, whose case vignettes provided the impetus for the scoping review. The scoping review analyzes the impact of place of residence and its intersection with barriers to accessing trans-related health care. PubMed and Web of Science Data bases were searched for relevant studies using a search strategy related to trans people and remote, rural, or suburban residences. 33 studies were selected after full-text screening and supplemented via reference list checks and study team expertise by 12 articles addressing the living conditions of remotely living trans people and describing requirements for trans-related health care. The literature on trans people living remotely reveals intersections of trans mental health with age, race, gender expression, geographic location, community size, socioeconomic status, discrimination experiences, and attitudes towards health care providers. Several structural health care barriers are identified. The role of health care professionals (HCPs) for remotely living trans people is discussed. There is no need assuming that rural life for trans people is inevitably worse for health and well-being than urban life. Nevertheless, some clear barriers and health disparities exist for trans people in remote settings. Empowering trans groups and diversity-sensitive education of remote communities in private and institutional settings are needed for respectful inclusion of trans people. Facilitating access to trans-related health care, such as through video-based e-health programs with HCPs, can improve both the health and socioeconomic situation of trans people.

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Section: Resultsmentioning

confidence: 99%

“…Samples often focus on middle-aged participants, neglecting trans youth in rural or suburban areas, where sparse research exists ( 22 ). However, trans people at the lower and higher ends of the age spectrum are particularly isolated in regards to health care ( 2 , 21 ).…”

Section: Resultsmentioning

confidence: 99%

Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review

et al. 2021

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“…In a sample of nearly 250 third- and fourth-year medical students, only 56% chose the correct definition of the term “transgender” [31]. Unsurprisingly, some of the frequently cited barriers to accessing care among transgender patients are the lack of knowledgeable providers (regarding body, identity, expression, etc, for transgender patients and transgender-specific care) [15,32,33] or the need for the patient to educate the provider [4], which may be magnified for patients in rural and remote locations [22,34]. Although medical training and curriculum need to include transgender topics [35], health systems face a concomitant, immediate need to equip current providers with necessary resources in order to provide transgender-specific health care for transgender patients.…”

Section: Discussionmentioning

confidence: 99%

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study

et al. 2019

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Background In 2015, the Department of Veterans Affairs (VA) nationally implemented a transgender e-consultation (e-consult) program with expert clinical guidance for providers. Objective This mixed-methods project aimed to describe providers’ program experiences, reasons for nonuse of the program, and ways to improve the program use. Methods From January to May 2017, 15 urban and rural VA providers who submitted at least one e-consult in the last year participated in semistructured interviews about their program experiences, which were analyzed using content analysis. From November to December 2017, 53 providers who encountered transgender patients but did not utilize the program participated in a brief online survey on the reasons for nonuse of the program and the facilitators encouraging use. Results Qualitative analysis showed that providers learned of the program through email; colleagues; the electronic health record (EHR) system; and participation in the VA Lesbian, Gay, Bisexual, and Transgender committees or educational trainings. Providers used the program to establish care plans, hormone therapy recommendations, sexual and reproductive health education, surgical treatment education, patient-provider communication guidance, and second opinions. The facilitators of program use included understandable recommendations, ease of use through the EHR system, and status as the only transgender resource for rural providers. Barriers to use included time constraints, communication-related problems with the e-consult, impractical recommendations for underresourced sites, and misunderstanding of the e-consult purpose. Suggestions for improvement included addition of concise or sectioned responses, expansion of program awareness among providers or patients, designation of a follow-up contact person, and increase in provider education about transgender veterans and related care. Quantitative analysis showed that the common reasons for nonuse of the program were no knowledge of the program (54%), no need of the program (32%), and receipt of help from a colleague outside of e-consult (24%). Common suggestions to improve the program use in quantitative analyses included provision of more information about where to find e-consult in the chart, guidance on talking with patients about the program, and e-mail announcements to improve provider awareness of the program. Post hoc exploratory analyses showed no differences between urban and rural providers. Conclusions The VA transgender e-consult program is useful for providers, but there are several barriers to implementing recommendations, some of which are especially challenging for rural providers. Addressing the identified barriers and enhancing the facilitators may improve program use and quality care for transgender veterans.

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“…In a sample of nearly 250 3 rd and 4 th year medical students, only 56% chose the correct definition of the term "transgender" [31]. Unsurprisingly, some of the most oft-cited barriers to accessing care among transgender patients are the lack of knowledgeable providers (e.g., regarding transgender patients [i.e., body, identity, expression] and transgender-specific care) [15,32,33], or the patient having to educate the provider [4], which may be magnified for patients in rural and remote locations [22,34].…”

Section: Discussionmentioning

confidence: 99%

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study (Preprint)

Blosnich¹,

Rodriguez²,

Hruska³

et al. 2018

Preprint

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communication-related problems with e-consult, impractical recommendations for underresourced sites, and misunderstanding e-consult purpose. Improvement suggestions included adding concise/sectioned responses, expanding provider/patient program awareness, designating a follow-up contact person, and increasing provider education about transgender Veterans and related care. Quantitative analysis found common reasons for not using the program were: not knowing about it, not needing to use it yet, and getting help from a colleague outside of econsult. Common suggestions to improve program use were: more information about where to find e-consult in the chart, guidance on talking with patients about the program, and e-mail announcements to improve provider awareness of the program. Post hoc exploratory analyses showed no differences between urban and rural providers. Conclusions:The VA transgender e-consult program is useful to providers, but there are several barriers to implementing recommendations, some of which are especially challenging for rural providers. Addressing noted barriers and enhancing the facilitators may improve program use and improve quality care for transgender Veterans.

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Health Differences Among Lesbian, Gay, and Transgender Veterans by Rural/Small Town and Suburban/Urban Setting

Cited by 24 publications

References 39 publications

Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review

Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study (Preprint)

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