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：将近20％的成年跨性别人口在美国军方服役。 VA 价值观并优先考虑旨在培养肯定文化并为变性者进行示例护理的研究 和性别多样性（TGD）退伍军人。考虑到TGD退伍军人的可能性高20倍，这项工作至关重要 与非TGD退伍军人相比，尝试自杀并经历大量的心理健康分布。 意义：虽然当前的VA研究正在研究健康服务的利用以及障碍和 促进者从TGD退伍军人和VA医疗保健提供者的角度照顾 缺乏为VA提供者提供资深的，基于证据的文化能力培训。 创新和影响：身份发展发展和共享（思想）是一种创新有效的 医疗保健提供者的污名培训涉及显示植根于TGD老兵的电影 与TGD退伍军人小组的叙述和引人入胜的提供者进行了主持的对话。 文献表明，基于绩效的干预措施比其他触发认知能力的可能性较小 培训方式，最大程度地提高他们接触可能不会寻求这种培训的提供者的能力。 具体目的：在AIM 1中，我们评估了思想对VA心理健康和初级保健提供者的影响， 询问“想法对提供者污名相信的影响是什么？”在AIM 2中，我们评估了想法可行性， 通过提供商，利益相关者和TGD老兵在印第安纳州VAMC和CBOC中的可接受性和实施 反馈，询问：‘VA初级保健和心理健康提供者的百分比参加了想法和 完成前/邮政测试吗？’我们还检查VA提供商，TGD退伍军人和服务线经理是否是否 考虑可行和可接受的想法，并确定相关的干预和设置的特征 取得成功。我们的次要目的是探索一个的可行性和初步结果 嵌套数据收集设计，以评估思想对TGD患者的影响 TGD患者完成有关患者对提供者文化能力的看法的调查前/后调查 “匹配的前调查中有多少百分比评估受思想培训的提供者？”假设：我们期望 想法将降低提供者的污名信念，满足可行性和可接受性基准，以及30％ TGD患者将完成有关其提供者感知的文化能力的调查。 方法论：我们将为看到TGD最多的患者的提供者实施想法 - 初级保健和 心理健康 - 在现有会议期间提供最大化参与度。我们将衡量：1） 预/后提供者的污名； 2）实施成功，障碍和促进者； 3）评估的可行性 TGD患者经历了经过培训的提供者的经验。预/帖子比较接受和行动 问卷调查 - 污名调查将反映对提供者污名的影响。该验证的得分较低， 可靠的措施，表明心理灵活性更大，并减少了制定的污名。数据将进行分析 使用适当的统计检验，核算方差，正态性和相关性。实施成功 将通过经过验证的可接受性和可行性的定量量度来评估 通过定性提供商，诊所负责人和TGD老兵访谈来访问并扩展 实施障碍/促进者。评估从TGD患者中收集数据的可行性 提供商我们将使用衡量患者看法的常见数据集进行TGD患者调查 提供者的文化能力预/后的想法和跟踪完成率。 下一步/实施：完成这些特定目标将导致资源的可见性提高 为了支持TGD医疗保健，有效性数据与医疗保健提供者的污名相关，以及 实施和可行性数据用于设计未来国家的实施和评估 部署想法以增强对TGD退伍军人的护理。