Narrative-Based Cultural Humility Training to Ensure Affirming Care for Transgender and Gender Diverse Veterans Across Services: A Pilot Feasibility Study

基于叙事的文化谦逊培训，以确保跨军种对跨性别和性别多样化退伍军人的肯定关怀：试点可行性研究

• 批准号: 10630434
• 负责人: Sally L Wasmuth
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10630434
• 关键词: Accounting; Address; Adult; Affect; Anxiety; Astronomy; Belief; Benchmarking; Caring; Characteristics; Clinic; Cognitive; Communication; Complex; Consolidated Framework for Implementation Research; Data; Data Collection; Data Set; Development; Effectiveness; Ensure; Equitable healthcare; Equity; Evaluation; Event; Evolution; Feasibility Studies; Feedback; Film; Future; Goals; Health Personnel; Healthcare; Heterogeneity; Indiana; Intervention; Interview; Knowledge; Learning; Letters; Literature; Measures; Mental Depression; Mental Health; Mental Health Services; Methodology; Methods; Military Personnel; Modality; Modeling; Normalcy; Outcome; Patient-Focused Outcomes; Patients; Perception; Performance; Personal Satisfaction; Population; Population Heterogeneity; Primary Care; Principal Investigator; Provider; Questionnaires; Reduce health disparities; Research; Research Priority; Resistance; Resources; Respondent; Sampling; Schedule; Services; Site; Social Change; Source; Suicide; Suicide attempt; Surveys; Testing; Training; United States; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Work; acceptability and feasibility; adverse outcome; care systems; cisgender; cultural competence; design; effectiveness/implementation hybrid; empowerment; evidence base; experience; flexibility; gender diversity; health assessment; health disparity; health equity; health service use; health training; high risk; implementation barriers; implementation design; implementation evaluation; implementation facilitators; implementation strategy; implicit bias; improved; innovation; meetings; primary care patient; primary care provider; programs; psychologic; shared decision making; social stigma; success; suicidal; tool; transgender

Background: Nearly 20% of the adult transgender population has served in the United States military. The VA values and prioritizes research that seeks to cultivate an affirming culture and exemplary care for transgender and gender diverse (TGD) Veterans. This work is critical, given that TGD Veterans are 20 times more likely to attempt suicide and experience vast mental health disparities compared with non-TGD Veterans. Significance: While current VA research is examining health services utilization as well as barriers and facilitators to care from the perspectives of TGD Veterans and VA healthcare providers, implementation of Veteran-informed, evidence-based cultural competence trainings for VA providers is lacking. Innovation and Impact: Identity Development Evolution and Sharing (IDEAS) is an innovative and effective stigma reduction training for healthcare providers that involves showing a film rooted in TGD Veteran narratives and engaging providers in a post-film, moderated conversation with a panel of TGD Veterans. Literature suggests performance-based interventions are less likely to trigger cognitive resistance than other training modalities, maximizing their ability to reach providers who may not otherwise seek out this training. Specific Aims: In Aim 1 we evaluate the impact of IDEAS on VA mental health and primary care providers, asking ‘What is the impact of IDEAS on provider stigma beliefs?’ In Aim 2 we evaluate IDEAS feasibility, acceptability, and implementation in Indiana VAMC and CBOCs via provider, stakeholder, and TGD Veteran feedback, asking: ‘What percentage of VA Primary Care and Mental Health providers attend IDEAS and complete pre/post tests?’ We also examine whether VA providers, TGD Veterans, and service line managers consider IDEAS feasible and acceptable and identify characteristics of the intervention and settings associated with implementation success. Our secondary aim is to explore the feasibility and preliminary outcomes of a nested data collection design for evaluating IDEAS’ impact on TGD patients by asking ‘What percentage of TGD patients complete pre/post surveys regarding patient perceptions of provider cultural competence’ and ‘What percentage of matched pre-post surveys evaluate IDEAS-trained providers?’ Hypotheses: We anticipate IDEAS will reduce providers’ stigma beliefs, meet feasibility and acceptability benchmarks, and that 30% of TGD patients will complete surveys about perceived cultural competence of their providers. Methodology: We will implement IDEAS for providers who see the most TGD patients – Primary Care and Mental Health – maximizing engagement by offering it during existing meeting times. We will measure: 1) pre/post provider stigma; 2) implementation success, barriers, and facilitators; and 3) feasibility of assessing TGD patient experiences with IDEAS trained providers. Pre/post comparison of Acceptance and Action Questionnaire – Stigma surveys will reflect impact on provider stigma. Lower scores on this validated and reliable measure indicate greater psychological flexibility and reduced enacted stigma. Data will be analyzed using appropriate statistical tests accounting for variance, normality, and correlation. Implementation success will be evaluated with post-IDEAS validated quantitative measures of acceptability and feasibility AS WELL AS REACH, and expanded via qualitative provider, clinic chief, and TGD veteran interviews to examine implementation barriers/facilitators. To assess feasibility of collecting data from TGD patients of IDEAS-trained providers we will conduct TGD patient surveys using common data set items that measure patient perceptions of provider cultural competence pre/post IDEAS and track completion rates. Next steps/Implementation: Accomplishing these specific aims will result in increased visibility of resources to support TGD healthcare, effectiveness data related to healthcare provider stigma reduction, and implementation and feasibility data to be used to design the implementation and evaluation of a future national deployment of IDEAS to enhance care for TGD Veterans.

背景：近20%的成年变性人曾在美国军队服役。退伍军人管理局 重视并优先考虑旨在培养肯定文化和对跨性别者的模范关怀的研究 和性别多样性（TGD）退伍军人。这项工作是至关重要的，因为TGD退伍军人有20倍的可能性， 与非TGD退伍军人相比，试图自杀并经历巨大的心理健康差异。 意义：虽然目前的VA研究正在研究卫生服务的利用以及障碍， 从TGD退伍军人和VA医疗保健提供者的角度来看， 缺乏退伍军人知情，以证据为基础的文化能力培训的VA供应商。 创新和影响：身份发展演变和共享（IDEAS）是一个创新和有效的 为医疗保健提供者提供减少耻辱感的培训，包括放映一部植根于TGD退伍军人的电影 叙述和从事供应商在电影后，主持对话与TGD退伍军人小组。 文献表明，基于表现的干预措施比其他干预措施更不可能引发认知阻力。 培训模式，最大限度地提高他们接触提供者的能力，否则他们可能不会寻求这种培训。 具体目标：在目标1中，我们评估了IDEAS对VA心理健康和初级保健提供者的影响， 询问“IDEAS对提供者污名信念的影响是什么？”在目标2中，我们评估了IDEAS的可行性， 可接受性，并通过供应商、利益相关者和TGD退伍军人在印第安纳州VAMC和CBOC中实施 反馈，问：“VA初级保健和心理健康提供者参加IDEAS的百分比是多少， 完成前/后测试？我们还研究了VA提供者，TGD退伍军人和服务线经理是否 考虑IDEAS的可行性和可接受性，并确定干预措施和相关环境的特征 实施成功。我们的第二个目标是探索一个 巢式数据收集设计，通过询问“ TGD患者完成关于患者对提供者文化能力的看法的前/后调查， “匹配的事前事后调查评估IDEAS培训提供者的百分比是多少？”假设：我们预期 IDEAS将减少提供者的耻辱信念，满足可行性和可接受性基准， TGD患者将完成关于其提供者的感知文化能力的调查。 方法：我们将为TGD患者最多的提供者实施IDEAS-初级保健和 心理健康-通过在现有会议时间内提供参与度来最大化参与度。我们将测量：1） 前/后提供者污名; 2）实施成功，障碍和促进者; 3）评估的可行性 TGD患者与IDEAS培训提供者的体验。接受和行动的前后比较 问卷调查-污名调查将反映对提供者污名的影响。此验证的分数较低， 可靠的措施表明，心理灵活性更大，制定的耻辱减少。将对数据进行分析 使用考虑方差、正态性和相关性的适当统计检验。实施成功 将通过IDEAS后确认的可接受性和可行性定量指标以及 REACH，并通过定性提供者，诊所主任和TGD资深人士的访谈进行扩展，以检查 执行障碍/促进因素。评估从接受IDEAS培训的TGD患者中收集数据的可行性 我们将使用测量患者感知的通用数据集项目对TGD患者进行调查 提供商的文化能力前/后IDEAS和跟踪完成率。 今后的步骤/实施：实现这些具体目标将提高资源的可见度 支持TGD医疗保健，与医疗保健提供者污名减少相关的有效性数据，以及 执行和可行性数据，以用于设计未来国家 部署IDEAS以加强对TGD退伍军人的照顾。