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: 10440272
• 负责人: WALTER O. BOCKTING
• 金额: $ 69.06万
• 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/10440272
• 关键词: Address; Admission activity; Affect; Area; Caring; Chronic; Clinical; Cohort Studies; Communities; Depression and Suicide; Development; Discipline of Nursing; Discrimination; 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 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; Research; Risk Behaviors; Sampling; Science; Self Care; Services; Sex Functioning; Social Well-Being; Societies; Stress; Structure; Time; Training; Trust; Visiting Nurse; Well in self; base; behavior influence; clinical practice; cohort; community based service; design; evidence base; experience; gender expression; gender minority; gender minority group; gender transition; health care availability; health care disparity; health disparity; health related quality of life; high risk; improved; informant; innovation; instrument; intersectionality; intimate behavior; member; 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.

项目总结/摘要 近年来，性别少数群体（GM）在美国社会中获得了更大的知名度。但是，物理 转基因个体的心理健康仍然是一个关键的公共卫生问题。转基因面临持续的耻辱， 歧视和服务障碍，影响他们的健康和福祉的生命过程中。性别 肯定是承认一个人的性别认同和表达的过程，这可能包括情感上的 支持以及社会和医疗干预;它与心理健康和福祉有关。 未满足的性别确认需求与转基因人群中更大的风险行为和更差的自我照顾有关， 特别是与艾滋病毒风险和治疗有关的问题。在提供性别肯定方面受过专门培训的临床医生 服务可能具有独特的定位，以支持转基因个体的情感需求，并有可能 对一个人在与医疗保健提供者互动时的信任和舒适度产生长期影响， 和保持护理，以及影响一个人一生健康轨迹的自我护理行为。 关于转基因个体在手术后的医疗保健需求缺乏证据，他们的 在他们的身份发展，他们的生活质量和长期的心理社会调整阶段， 身心健康这项前瞻性、混合方法、纵向队列研究的目的是 建立一个丰富的证据基础，在性别确认手术后， 转基因个体的医疗保健需求，检查生活质量的多个领域的变化， 与医疗保健提供者的关系。采用定量和定性相结合的方法，我们 具体目标是： 1.记录GM个体随时间的变化（N = 300，从一个性别确认，手术后 家庭保健计划）手术后的社会心理发展，包括以下领域：（i）性别 （二）亲密和关系，（三）社会和社区支持，（四） 就业和经济福利，以及（v）环境控制和生活目标。 2.检查手术后转基因个体健康相关生活质量的变化，包括以下领域： (i)身体健康，（二）心理健康和社会福祉，（三）性功能，满意度和健康，（四） 健康行为和自我保健，以及（v）参与和保留医疗保健以及与 医疗保健提供者。 3.确定全球机制个人参与自我照顾和参与的障碍和促进因素， 留在家中，随后接受与性别有关的保健和其他保健问题的保健。 这项研究将解决目前支持转基因个体的最佳做法证据中的一个重大差距 在关键的生命历程过渡期间，有可能改善他们对护理的参与， 影响这一人群的医疗保健获取、结果和生活质量的普遍差异。