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Healthcare
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Sexual and Gender Diversity in Healthcare Provision
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Sexual and Gender Diversity in Healthcare Provision

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 23711

Special Issue Editor

Dr. Ana Cristina Santos

E-Mail Website
Guest Editor
Centre for Social Studies, University of Coimbra, 3000-995 Coimbra, Portugal
Interests: LGBTI+ studies; intimate, sexual and reproductive citizenship; socio-legal studies of sexuality; childhood, ageing and life course approaches to sexual and gender diversity

Special Issue Information

Dear Colleagues,

Sexual and gender diversity has been at the forefront of political and juridical battles, leading to significant social transformations in recent decades. These changes have considerable impacts on the health sector, both for professionals and patients.

In line with supranational directives, National Health Services are increasingly advocating for excellence in healthcare provision regardless of sexual orientation and gender identity and expression. This change in health policies requires not only a transformation in principle but foremost a transformation in practices. With variations according to context and time, healthcare provision targeting LGBTQI+ patients differs enormously from acclaimed guidelines, norms, and progressive legal frameworks. Across the globe, health professionals struggle to grasp new knowledge and to update their practices aiming at creating an inclusive and safe environment for patients in terms of sexual and gender diversity. When aiming to do so, health professionals often face obstacles stemming from anti-gender and anti-sexuality backlash, lack of training in medical schools, absence of adequate information, and the resilience of a dominant hetero/cisnormative culture that discourages inclusive LGBTQI+ healthcare practices.

With a focus on healthcare provision by professionals, this Special Issue invites contributions that reflect on the impacts of both inclusive LGBTQI+ healthcare practices on one hand, and of healthcare practices that (re)produce inequalities based on hetero/cisnormative patterns on the other. With this emphasis on the provision of healthcare in mind, we are particularly interested in papers that explore one or more of the following topics:

  • Ageing and healthcare provision for LGBTQI+ elders;
  • The impact of anti-gender and anti-sexuality movements in the health sector;
  • Backlash and failure in LGBTQI+ healthcare provision;
  • Challenges faced by LGBTQI+ health professionals;
  • Good practices in LGBTQI+ healthcare provision;
  • Healthcare provision for trans, intersex, and non-binary patients;
  • Healthcare provision for lesbian and bisexual women;
  • Healthcare provision for gay and bisexual men;
  • Hetero/cisnormativity in medical school curricula;
  • LGBTQI+ healthcare provision over the lifespan, including children and youth;
  • Policies for a more inclusive healthcare provision;
  • Practices of medicalization and depathologization of LGBTQI+ people;
  • Trans reproductive medicine.

We welcome contributions from a range of fields of study, including (but not limited to) aging studies, crip studies/critical disability studies, gender studies, gerontology, LGBTQI+ studies, mad studies, medical anthropology, and the sociology of health, amongst others. We would also encourage submissions from countries or regions in which the knowledge dissemination in this field has been sparse (e.g., Southern, Central, and Eastern Europe, West and Central Africa, South and Central America, etc.).

Dr. Ana-Cristina Santos
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Sexual and gender diversity
  • LGBTQI+
  • Healthcare provision
  • Hetero/cisnormativity
  • Medicalization and (de)pathologization
  • Health policies

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Published Papers (6 papers)

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Research

11 pages, 471 KiB  
Article
“The Light at the End of the Tunnel”: Experiences of LGBTQ+ Adults in Portuguese Healthcare
by Mara Pieri and Joana Brilhante
Healthcare 2022, 10(1), 146; https://doi.org/10.3390/healthcare10010146 - 13 Jan 2022
Cited by 9 | Viewed by 3048
Abstract
This work analyses experiences of LGBTQ+ people accessing healthcare in Portugal. A total of 32 semi-structured interviews were conducted with queer adults (18–59 years old). The thematic analysis and thematic networks brought to light how structural cis-heteronorms are compliant with the maintenance of [...] Read more.
This work analyses experiences of LGBTQ+ people accessing healthcare in Portugal. A total of 32 semi-structured interviews were conducted with queer adults (18–59 years old). The thematic analysis and thematic networks brought to light how structural cis-heteronorms are compliant with the maintenance of invisibility regarding sexual and gender diversity. As a consequence, experiences of direct and indirect discrimination show us how crucial it is to have well prepared healthcare providers, capable of embracing diversity and creating safe spaces that allow us to shorten the path between Portugal’s progressive legal frame and the people lived experiences. Full article
(This article belongs to the Special Issue Sexual and Gender Diversity in Healthcare Provision)
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12 pages, 426 KiB  
Article
Physical and Mental Disabilities among the Gender-Diverse Population Using the Behavioral Risk Factor Surveillance System, BRFSS (2017–2019): A Propensity-Matched Analysis
by Jennifer R. Pharr and Kavita Batra
Healthcare 2021, 9(10), 1285; https://doi.org/10.3390/healthcare9101285 - 28 Sep 2021
Cited by 7 | Viewed by 3216
Abstract
This propensity-matched analysis utilized the publicly available Behavioral Risk Factor Surveillance System (2017–2019) data to compare the burden of disabilities among transgender/non-binary (TGNB) and cisgender groups. The groups were matched (1:1 ratio) on demographic variables using Nearest Neighborhood Matching. Categorical variables were compared [...] Read more.
This propensity-matched analysis utilized the publicly available Behavioral Risk Factor Surveillance System (2017–2019) data to compare the burden of disabilities among transgender/non-binary (TGNB) and cisgender groups. The groups were matched (1:1 ratio) on demographic variables using Nearest Neighborhood Matching. Categorical variables were compared among groups using a Chi-square analysis to test differences in the proportions. Multivariate logistic regression analysis was fit to predict the likelihood of the physical and mental disabilities among the TGNB group compared with the cisgender group while controlling for healthcare access factors, income, and employment. Survey weights were included in the model to account for the complex survey design. In a weighted sample of 664,103 respondents, only 2827 (0.4%) self-identified as TGNB. In the matched sample, a higher proportion of the TGNB group belonged to the low-income group (39.5% vs. 29.8%, p < 0.001), were unable to work (12.5% vs. 8.6%, p < 0.001), and delayed care due to cost barriers (19.0% vs. 12.4%, p < 0.001). Compared with the cisgender group, the odds of having difficulty making decisions were 1.94 times higher (95% CI: 1.67–2.27) and odds of difficulty walking were 1.38 times higher (95% CI: 1.19, 1.59) among the TGNB group. Additionally, the TGNB group had 59.8% higher adjusted odds ratio (aOR) (aOR 1.598, 95% Confidence interval (CI): 1.256, 2.034) of experiencing difficulty dressing and 83.3% higher odds (aOR 1.833, 95% CI: 1.533, 2.191) in having difficulty doing things alone. The findings of this study advocate for developing policies and interventions to deliver culturally competent care to the TGNB population with disabilities. Full article
(This article belongs to the Special Issue Sexual and Gender Diversity in Healthcare Provision)
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15 pages, 305 KiB  
Article
The Impact of Training in Transgender Care on Healthcare Providers Competence and Confidence: A Cross-Sectional Survey
by Aisa Burgwal, Natia Gvianishvili, Vierge Hård, Julia Kata, Isidro García Nieto, Cal Orre, Adam Smiley, Jelena Vidić and Joz Motmans
Healthcare 2021, 9(8), 967; https://doi.org/10.3390/healthcare9080967 - 30 Jul 2021
Cited by 26 | Viewed by 5795
Abstract
All studies to date demonstrate a lack of access to care for transgender people. A few educational efforts in providing care to transgender people have been successful. However, one challenge in administering training is that there is almost no research on the need [...] Read more.
All studies to date demonstrate a lack of access to care for transgender people. A few educational efforts in providing care to transgender people have been successful. However, one challenge in administering training is that there is almost no research on the need of healthcare providers (HCP) to acquire knowledge, as well as on the effect of training on their level of competence and confidence in working with transgender people. Results from an online survey of a convenience sample of HCP across four different European countries (N = 810) showed that 52.7% reported experiences with some form of training on transgender people. The mean confidence level for all HCP (with or without training) in working with transgender people was 2.63, with a significant effect of training on confidence. 92.4% of HCP believed that training would raise their competence, and this belief was significantly higher among HCP with training experience, HCP working in Serbia and Sweden and/or among those HCP who belong to a sexual minority group. General practitioners had the lowest confidence levels of all professions involved. The study provided strong support for the use of training in improving healthcare conditions for transgender people, not only to raise awareness among HCP, but also to increase knowledge, competence and confidence levels of HCP in working with transgender people. Full article
(This article belongs to the Special Issue Sexual and Gender Diversity in Healthcare Provision)
16 pages, 730 KiB  
Article
Propensity Score Analysis Assessing the Burden of Non-Communicable Diseases among the Transgender Population in the United States Using the Behavioral Risk Factor Surveillance System (2017–2019)
by Jennifer R. Pharr and Kavita Batra
Healthcare 2021, 9(6), 696; https://doi.org/10.3390/healthcare9060696 - 9 Jun 2021
Cited by 17 | Viewed by 3683
Abstract
Research to assess the burden of non-communicable diseases (NCDs) among the transgender population needs to be prioritized given the high prevalence of chronic conditions and associated risk factors in this group. Previous cross-sectional studies utilized unmatched samples with a significant covariate imbalance resulting [...] Read more.
Research to assess the burden of non-communicable diseases (NCDs) among the transgender population needs to be prioritized given the high prevalence of chronic conditions and associated risk factors in this group. Previous cross-sectional studies utilized unmatched samples with a significant covariate imbalance resulting in a selection bias. Therefore, this cross-sectional study attempts to assess and compare the burden of NCDs among propensity score-matched transgender and cisgender population groups. This study analyzed Behavioral Risk Factor Surveillance System data (2017–2019) using complex weighting procedures to generate nationally representative samples. Logistic regression was fit to estimate propensity scores. Transgender and cisgender groups were matched by sociodemographic variables using a 1:1 nearest neighbor matching algorithm. McNemar, univariate, and multivariate logistic regression analyses were conducted among matched cohorts using R and SPSS version 26 software. Compared with the cisgender group, the transgender group was significantly more likely to have hypertension (31.3% vs. 27.6%), hypercholesteremia (30.8% vs. 23.7%), prediabetes (17.3% vs. 10.3%), and were heavy drinkers (6.7% vs. 6.0%) and smokers (22.4% vs. 20.0%). Moreover, the transgender group was more than twice as likely to have depression (aOR: 2.70, 95% CI 2.62–2.72), stroke (aOR: 2.52 95% CI 2.50–2.55), coronary heart disease (aOR: 2.77, 95% CI 2.74–2.81), and heart attack (aOR: 2.90, 95% CI 2.87–2.94). Additionally, the transgender group was 1.2–1.7 times more likely to have metabolic and malignant disorders. Differences were also found between transgender subgroups compared with the cisgender group. This study provides a clear picture of the NCD burden among the transgender population. These findings offer an evidence base to build health equity models to reduce disparities among transgender groups. Full article
(This article belongs to the Special Issue Sexual and Gender Diversity in Healthcare Provision)
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13 pages, 253 KiB  
Article
LGBTQI+ Healthcare (in)Equalities in Portugal: What Can We Learn from Asexuality?
by Rita Alcaire
Healthcare 2021, 9(5), 583; https://doi.org/10.3390/healthcare9050583 - 14 May 2021
Cited by 2 | Viewed by 3285
Abstract
The main purpose of this article is to analyse how healthcare providers in Portugal perceive asexuality. To do so, the author makes use of qualitative data from both the CILIA LGBTQI+ Lives project and The Asexual Revolution doctoral research on asexuality in Portugal, [...] Read more.
The main purpose of this article is to analyse how healthcare providers in Portugal perceive asexuality. To do so, the author makes use of qualitative data from both the CILIA LGBTQI+ Lives project and The Asexual Revolution doctoral research on asexuality in Portugal, namely, a focus group conducted with healthcare providers, drawing from their assessment of interview excerpts with people identifying as asexual. The data were explored according to thematic analysis and revealed three major tendencies: (1) old tropes at the doctor’s office; (2) narratives of willingness to learn about the subject; and (3) constructive and encouraging views of asexuality. From this analysis, valuable lessons can be drawn concerning the respect for gender and sexual diversity. The author argues that both formal and informal learning play an important role in building cultural competence among healthcare providers. This could be achieved both by introducing sexual and gender diversity in curricula in HE and through media exposure on these subjects. Overall, it will lead to building knowledge and empathy about marginalised groups, and will help fight inequalities of LGBTQI+ people in healthcare. As such, LGTBQI+ activism that puts the topics of asexuality and LGBTQI+ in the media agenda, is a powerful strategy. Hence, because healthcare providers show willingness to learn, the media becomes a source for learning about asexual and LGTBQI+ experiences, which they can incorporate in their medical practice. Full article
(This article belongs to the Special Issue Sexual and Gender Diversity in Healthcare Provision)
10 pages, 287 KiB  
Article
Sexuality Attitudes and Beliefs Survey (SABS): Validation of the Instrument for the Spanish Nursing Students
by Ana Maria Aguiar Frias, Irene Soto-Fernandez, Luís Manuel Mota de Sousa, Sagrario Gómez-Cantarino, Maria da Luz Ferreira Barros, Maria Jesús Bocos-Reglero, Vicki Aaberg, Ermelinda Caldeira and Margarida Sim-Sim
Healthcare 2021, 9(3), 294; https://doi.org/10.3390/healthcare9030294 - 8 Mar 2021
Cited by 8 | Viewed by 2695
Abstract
Patient sexuality is a fundamental subject in nursing student’s education. However, beliefs about patient sexuality can influence the care offered. The aim of this psychometric study was to describe the validation process and the psychometrics properties of the Sexuality Attitudes and Beliefs Survey [...] Read more.
Patient sexuality is a fundamental subject in nursing student’s education. However, beliefs about patient sexuality can influence the care offered. The aim of this psychometric study was to describe the validation process and the psychometrics properties of the Sexuality Attitudes and Beliefs Survey (SABS) for Spanish nursing students. The convenience sample was 283 nursing students from a state university in Spain. Participants ranged from 18 to 30 years (M = 19.66; SD = 1.85). Data collection happened in 2019–2020. The translation, back translation and adaptation to Spanish was discussed and refined, ensuring the semantic, idiomatic and conceptual meaning of the items. The psychometric properties were assessed through analysis of validity and reliability. The Cronbach’s alpha for the final version of 12 items was 0.65. Although it has low reliability, the Spanish version of the SABS seems to be a valid and useful tool to measure nursing students’ beliefs about patient sexuality. In addition, it can be a resource for the assessment of the ability of Spanish nursing faculty in engaging topics involving the student’s vision of patient sexuality. Full article
(This article belongs to the Special Issue Sexual and Gender Diversity in Healthcare Provision)
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