TransHealthGUIDE: Transforming Health for Gender-Diverse Youth Using Interventions to Drive Equity

TransHealthGUIDE：利用干预措施推动公平，改变性别多元化青年的健康状况

• 批准号: 10413458
• 负责人: Sari Reisner
• 金额: $ 326.67万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10413458
• 关键词: Accounting; Address; Adolescent; Adolescent and Young Adult; Age; Anxiety; Area; Birth; Caregiver support; Caregivers; Caring; Cause of Death; Collaborations; Communication; Communities; Consultations; Continuing Education; Dose; Effectiveness; Ethnic Origin; Evidence based intervention; Face; Feeling suicidal; Focus Groups; Gender; Gender Identity; General Population; Health; Health Services Accessibility; Healthcare; Heterogeneity; Hispanic; Hour; Improve Access; Individual; Intake; Intervention; Knowledge; Learning Module; Measures; Medical; Mental Health; Methods; Minority; National Institute of Child Health and Human Development; National Institute of Mental Health; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Population; Population Heterogeneity; Provider; Public Health; Race; Randomized; Recommendation; Reporting; Reproducibility; Resources; Risk; Specialist; Stress; Structure; Suicide; Suicide attempt; System; Testing; Time; Training; Training Support; United States National Institutes of Health; Youth; arm; base; care providers; cisgender; density; digital; effectiveness testing; effectiveness/implementation study; effectiveness/implementation trial; empowerment; evidence base; experience; experimental study; family support; health disparity; health disparity populations; health equity; health inequalities; high risk; hormone therapy; improved; innovation; multiphase optimization strategy; peer; primary outcome; programs; provider networks; psychological distress; racial diversity; racial minority; reducing suicide; resilience; response; secondary outcome; sex; simulation; social health determinants; social stigma; social structure; suicidal risk; suicide rate; systemic intervention; transgender; treatment as usual; treatment effect

Revised Abstract Transgender and gender diverse (TGD) youth (ages 15-24), with gender identities differing from their sex assigned at birth, are a growing NIH-designated health disparities population. TGD youth suffer higher rates of suicide than their cisgender counterparts; over half contemplate suicide in their lifetime. These and other health disparities are compounded for TGD youth who are Black or Hispanic and experience both gender- and race-based stigma and minority stress. Black adolescents are also at an increased risk of suicide; attempts increased 73% from 1991 to 2017. Interventions are needed urgently to improve the mental health of TGD youth, particularly TGD youth who are also racial minorities. We propose a transformative, multi-level intervention to advance equity and reduce health disparities for TGD youth through individual, interpersonal, systemic, and community-based changes that increase knowledge and support among providers, youth, and caregivers, thereby reducing suicidality and improving mental health. Provider and family/caregiver support are known to be critical determinants of mental health outcomes for TGD youth, yet no large-scale interventions exist to address these remediable structural and social determinants of health. Our intervention has two components. The first is a provider training and support program. This entails a free online training course for continuing education credit that teaches providers how to support and communicate effectively with TGD patients and a provider network for increasing psychosocial support. The second is an interactive educational digital platform for TGD youth and caregivers. The digital platform provides expert-generated knowledge via educational modules and uses interactive features to promote communication and strengthen relationships between youth and caregivers. We will use a Multiphase Optimization Strategy (MOST) framework to optimize the platform for testing in a hybrid effectiveness-implementation trial with an Immediate Arm (upfront access) and Deferred Arm (access at 6 months). The intervention period for each Arm will last 6 months, followed by an observation period of up to 12 months with continued access. Using validated subscales, we will assess changes in the proportion of individuals reporting suicidal ideation in the prior three months (primary outcome) and in psychological distress and anxiety, caregiver support, and health care empowerment (secondary outcomes), as well as dose effects, heterogeneity of treatment effects across groups, and within- group resilience factors. This innovative, multi-level intervention fulfills a significant unmet need for near-term and sustainable solutions to the health disparities faced by TGD youth and addresses intersecting forms of stigma and inequity to transform mental health outcomes for a highly vulnerable, at-risk youth population.

修订摘要 跨性别和性别多样性（TGD）青年（15-24岁），性别认同与出生时分配的性别不同，是NIH指定的健康差异人群的日益增长。 TGD青年的自杀率高于其Cisgender对手。超过一半的人在一生中考虑自杀。对于黑人或西班牙裔的TGD青年而言，这些健康差异和其他健康差异都更加复杂，并经历了基于性别和种族的污名和少数派压力。黑人青少年的自杀风险也增加。从1991年到2017年，尝试增加了73％。迫切需要进行干预，以改善TGD青年的心理健康，尤其是TGD青年，他们也是种族少数群体。我们提出了一种变革性的多层次干预措施，以通过个人，人际，系统性和社区的变化来促进TGD青年的健康差异，从而增加提供者，青年和看护者的知识和支持，从而减少自杀性和改善心理健康。众所周知，提供者和家庭/护理人员的支持是TGD青年心理健康成果的关键决定因素，但没有大规模干预措施来解决这些可补充的健康和社会健康决定因素。我们的干预有两个组成部分。首先是提供者培训和支持计划。这需要一个免费的在线培训课程，用于继续教育学分，该课程教授提供者如何与TGD患者和提供者网络有效地支持和沟通，以增加社会心理支持。第二个是针对TGD青年和护理人员的互动教育数字平台。该数字平台通过教育模块提供了专家生成的知识，并使用互动功能来促进青年与看护者之间的沟通和增强关系。我们将使用多相优化策略（大多数）框架来优化与即时ARM（前期访问）和递延ARM（6个月访问）的混合有效性试验中测试的平台。每个手臂的干预期将持续6个月，随后访问长达12个月的观察期。使用经过验证的子量表，我们将评估在前三个月（主要结果）以及心理困扰和焦虑，护理人员支持和赋予医疗保健赋权（次要结果）以及剂量效应，治疗效果的异质性，跨组互补剂以及群体弹性因素的异质性，在前三个月中报告自杀意念的比例的变化。这种创新的多层次干预措施满足了对TGD青年面临的健康差异的近期和可持续解决方案的巨大需求，并解决了与污名的相交形式和不平衡的形式，以改变高度易受伤害，高危的年轻人的心理健康成果。

项目成果

Gender Affirmation-Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study.

• DOI: 10.2196/45952
• 发表时间: 2023-08-15
• 期刊: JMIR FORMATIVE RESEARCH
• 影响因子: 2.2
• 作者: Boskey, Elizabeth R.;Quint, Meg;Xu, Rena;Kremen, Jessica;Estrada, Carlos;Tham, Regina;Kane, Kaiden;Reisner, Sari L.
• 通讯作者: Reisner, Sari L.