Using telehealth to improve access to gender-affirming care for BIPOC and rural gender diverse youth

项目总结 这项建议旨在改善对特别强调通知中所列特定人群的护理(不是- HS-21-014)通过增加涉及变性人和性别的卫生服务研究来促进卫生公平 多样化的青年、认同为黑人、土著或有色人种的青年(BIPOC)，以及生活在农村的青年 社区。认同BIPOC的性别多元化青年(GDY)以及生活在农村社区的青年， 他们比同龄人更容易经历抑郁和焦虑。1-5此外，BIPOC和农村GDY 在儿科性别诊所中比例过低，6-8人限制了他们接触儿科性别的机会- 肯定护理，这已被证明可以改善精神健康结果。9，10一项建议的解决方案 改善目前在大型学术医疗中心提供的性别平等医疗服务的机会 促进其在社区环境中的交付。先前的研究表明GDY和社区儿科 提供者对基于社区的护理提供模式感兴趣，特别是那些将 来自性别问题专家的基于技术的支持；11，12然而，其他利益攸关方参与的研究是 需要确保干预措施满足GDY及其家庭的需要。考虑到很少有供应商收到 这方面的培训13-15，大多数缺乏咨询变性人专家、远程保健的机会 远程医疗和电子会诊等模式在促进提供 以社区为基础的性别肯定关怀。不幸的是，关于现有模型是否能提供 向GDY及其家人提供必要的心理社会支持。在这份K08提案中，Sequeira博士将在她的基础上 与GDY、他们的家人和社区儿科提供者进行的现有研究：1)确定现有障碍 BIPOC和农村GDY接受性别肯定关怀的经验和探索设计与实施 促进通过远程保健获得护理的考虑，2)发展以技术为基础的增强性别 支持(TEGS)平台，促进在社区提供全面的性别肯定关怀 儿科环境，以及3)进行初步研究，以确定TEGS平台的可行性和可接受性 在社区环境中使用。此外，这个K08奖项将提供必要的技能和初步数据 通知未来R01提案的制定和提交，以进行随机试验以评估 TEGS平台使用对GDY心理健康、感知护理需求及社区的影响 提供商的知识和行为。

PROJECT SUMMARY This proposal aims to improve the care of specific populations included in the special emphasis notice (NOT- HS-21-014) to advance health equity by increasing health services research involving transgender and gender diverse youth, youth who identify as Black, Indigenous, or People of Color (BIPOC), and youth living in rural communities. Gender diverse youth (GDY) who identify BIPOC, as well as those living in rural communities, are more likely to experience depression and anxiety than their peers.1-5 Additionally, BIPOC and rural GDY are disproportionately underrepresented in pediatric gender clinics,6-8 limiting their access to pediatric gender- affirming care, which has been shown to improve mental health outcomes.9,10 One proposed solution for improving access to gender-affirming care, which is currently provided in large academic medical centers, is facilitating its delivery in the community setting. Prior research suggests both GDY and community pediatric providers are interested in community-based care delivery models, especially those that incorporate technology-based support from gender specialists;11,12 however, additional stakeholder-engaged research is needed to ensure interventions meet the needs of GDY and their families. Given few providers have received training in this area13-15 and most lack opportunities to consult with transgender specialists, telehealth modalities like telemedicine and electronic consultation show great potential in facilitating the provision of community-based gender-affirming care. Unfortunately, little is known about whether existing models provide necessary psychosocial support to GDY and their families. In this K08 proposal, Dr. Sequeira will build on her existing research with GDY, their families, and community pediatric providers to: 1) identify existing barriers BIPOC and rural GDY experience to receiving gender-affirming care and explore design and implementation considerations for facilitating access to care via telehealth, 2) develop a Technology-based Enhanced Gender Support (TEGS) platform to facilitate comprehensive gender-affirming care provision in the community pediatric setting, and 3) conduct a pilot study to determine the feasibility and acceptability of TEGS platform use in the community setting. In addition, this K08 award will provide the necessary skills and preliminary data to inform the development and submission of a future R01 proposal to conduct a randomized trial to evaluate the efficacy of TEGS platform use on GDY’s mental health and perceived care needs as well as community provider knowledge and behavior.