Gender Affirmation, Quality of Life, and Access to Care: A Mixed-Method Longitudinal Investigation

性别肯定、生活质量和获得护理的机会：混合方法纵向调查

• 批准号: 10618900
• 负责人: WALTER O. BOCKTING
• 金额: $ 70.91万
• 依托单位: VISITING NURSE SERVICE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10618900
• 关键词: Admission activity; Affect; Area; Caring; Chronic; Clinical; Cohort Studies; Communities; Community Health; Development; Discipline of Nursing; Discrimination; Disparity; Emotional; Employment; Environment; Face; Future; Gender; Gender Confirmation Surgery; Gender Identity; Goals; HIV risk; Health; Health Personnel; Health Services; Health Services Accessibility; Health behavior; Healthcare; Home; Home Care Services; Individual; Intervention; Interview; Investigation; Life; Life Cycle Stages; Link; Longitudinal cohort study; Medical; Mental Depression; Mental Health; Methods; Modeling; New York; Nursing Services; Operative Surgical Procedures; Outcome; Participant; Personal Satisfaction; Persons; Phase; Population; Positioning Attribute; Preparation; Process; Public Health; Qualitative Methods; Quality of life; Race; Research; Risk Behaviors; Sampling; Science; Self Care; Services; Sex Functioning; Social Well-Being; Societies; Stress; Structure; Suicide; Time; Training; Trust; Visiting Nurse; Well in self; behavior influence; clinical practice; cohort; community based service; design; disparity reduction; evidence base; experience; gender affirmation; gender affirming care; gender expression; gender minority; gender minority group; gender transition; health assessment; health care availability; health care disparity; health disparity; health related quality of life; high risk; improved; informant; innovation; instrument; intersectionality; intimate behavior; member; nonbinary; physical conditioning; programs; prospective; psychosocial adjustment; psychosocial development; recruit; resilience; satisfaction; service programs; sexual identity; social; social stigma; socioeconomics; transgender

PROJECT SUMMARY/ABSTRACT Gender minorities (GM) have gained greater visibility in U.S. society in recent years. However, the physical and mental health of GM individuals remains a critical public health issue. GM face persistent stigma, discrimination, and barriers to services that affect their health and wellbeing over the life course. Gender affirmation is a process of recognizing a person’s gender identity and expression, which may include emotional support as well as social and medical interventions; it has been associated with mental health and wellbeing. Unmet needs for gender affirmation have been linked to greater risk behavior and poorer self-care among GM, particularly related to HIV risk and treatment. Clinicians who are specially trained in providing gender-affirming services may be uniquely positioned to support the emotional needs of GM individuals, with the potential to have a long-term impact on a person’s trust and comfort in interacting with healthcare providers, engagement and retention in care, and self-care behaviors that influence one’s health trajectory over the life course. There is a dearth of evidence on the healthcare needs of GM individuals after surgery, their psychosocial adjustment during this phase of their identity development, their quality of life, and long-term physical and emotional wellbeing. The goal of this prospective, mixed method, longitudinal cohort study is to build a rich evidence base on GM identity development after gender-affirming surgery and the long-term healthcare needs of GM individuals, examining changes in multiple domains of quality of life and their relationships with healthcare providers. Using a combination of quantitative and qualitative methods, our specific aims are to: 1. Document changes over time in GM individuals’ (N = 300 recruited from a gender-affirming, post-surgical home healthcare program) psychosocial development after surgery, including such domains as (i) gender and sexual identity development, (ii) intimacy and relationships, (iii) social and community support, (iv) employment and financial wellbeing, and (v) environmental mastery and purpose in life. 2. Examine changes in GM individuals’ health-related quality of life after surgery, including such domains as (i) physical health, (ii) mental health and social wellbeing, (iii) sexual function, satisfaction and health, (iv) health behaviors and self-care, and (v) engagement and retention in healthcare and relationships with healthcare providers. 3. Identify barriers and facilitators to GM individuals’ engagement with their self-care and engagement and retention in home and subsequent healthcare for both gender-related and other health concerns. The study will address a significant gap in the current evidence on best practices to support GM individuals during a pivotal life course transition, with the potential to improve their engagement in care and mitigate the pervasive disparities in healthcare access, outcomes, and quality of life affecting this population.

项目摘要/摘要 近年来，性别少数群体（GM）在美国社会上获得了更大的知名度。但是，身体 通用汽车个人的心理健康仍然是一个关键的公共卫生问题。 GM面对持续的污名， 歧视，以及影响他们在生活过程中的健康和福祉的服务障碍。性别 肯定是认识一个人的性别认同和表达的过程，其中可能包括情感 支持以及社会和医疗干预措施；它与心理健康和福祉有关。 对性别感情的未满足需求与通用汽车的更大风险行为和自我保健相关， 特别与艾滋病毒风险和治疗有关。经过专门培训的临床医生提供性别肯定 服务可能是独特的，以支持通用汽车个人的情感需求，并有可能 长期对一个人在与医疗保健提供者互动时的信任和舒适感产生长期影响 以及保留护理以及影响人生过程中健康轨迹的自我保健行为。 关于手术后通用汽车个人的医疗保健需求的证据死亡 在其身份发展，生活质量和长期的这一阶段的社会心理调整 身体和情感健康。这种前瞻性，混合方法的纵向队列研究的目的是 在性别表达手术和长期后，建立有关转基因身份发展的丰富证据基础 通用汽车个人的医疗保健需求，检查生活质量及其多个领域的变化 与医疗保健提供者的关系。使用定量和定性方法的组合，我们 具体目的是： 1。通用汽车个人随时间变化的文档（n = 300个从性别肯定的后手术后招募的300个 家庭医疗保健计划）手术后的社会心理发展，包括（i）性别的领域 以及性认同发展，（ii）亲密和关系，（iii）社会和社区支持，（iv） 就业和财务福祉，以及（v）生活中的环境掌握和目的。 2。检查GM个人与健康相关的生活质量的变化，包括 （i）身体健康，（ii）心理健康和社会福祉，（iii）性功能，满意度和健康，（iv） 健康行为和自我保健，以及（v）医疗保健中的参与和保留以及与 医疗保健提供者。 3.确定通用汽车个人与他们的自我保健和参与的障碍和促进者 保留家庭和随后的医疗保健，以与性别相关和其他健康问题。 这项研究将解决当前有关支持通用汽车个人的最佳实践证据的差距 在关键的生活课程过渡期间，有可能改善他们在护理方面的参与并减轻 医疗保健访问，成果和生活质量影响这一人群的普遍分布。