Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention. (December 2017)

• Record Type: Journal Article
• Authors: White Hughto, Jaclyn M.; Clark, Kirsty A.; Altice, Frederick L.; Reisner, Sari L.; Kershaw, Trace S.; Pachankis, John E.
• Is Part Of: Social science & medicine. Volume 195(2017)
• Page Start: 159
• Page End: 169
• Publication Date: 2017-12
• Subjects: Transgender -- Healthcare -- Incarceration -- Providers -- Intervention; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2017.10.004
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: 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 2 = 23.21; p < 0.001). On average, transgender cultural competence (χ 2 = 22.49; p < 0.001), medical gender affirmation knowledge (χ 2 = 11.24; p = 0.01), self-efficacy to initiate hormones for transgender women, and subjective norms related to transgender care (χ 2 = 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. Highlights: Many correctional healthcare providers lack training in transgender care. Theoretically informed trainings hold promise for improving correctional healthcare. We created a transgender competence intervention for correctional providers. The intervention was found to be highly feasible and acceptable. The intervention yielded improvements in providers' transgender competencies.