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TransHealthGUIDE: Transforming Health for Gender-Diverse Youth Using Interventions to Drive Equity

TransHealthGUIDE：利用干预措施推动公平，改变性别多元化青年的健康状况

基本信息

批准号：
10831881
负责人：
Sari Reisner
金额：
$ 134.46万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-23 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10831881
关键词：
Accounting Address Adolescent Adolescent and Young Adult Age Anxiety Area Black race Caregiver support Caregivers Caring Cause of Death Collaborations Communication Communities Community of Practice Consultations Continuing Education Disparity Dose Education Educational process of instructing Effectiveness Equity Ethnic Origin Evidence based intervention Face Family Feeling suicidal Focus Groups Gender Gender Identity General Population Health Health Services Accessibility Healthcare Heterogeneity Hispanic Hour Improve Access Individual Inequity Intervention Knowledge Learning Module Measures Medical Mental Health Methods National Institute of Child Health and Human Development National Institute of Mental Health National Institute on Minority Health and Health Disparities Outcome Participant Pathway interactions Patient Self-Report Patients Population Provider Psychosocial Assessment and Care Public Health Race Randomized Recommendation Reduce health disparities Reporting Reproducibility Resources Risk Specialist Suicide Suicide attempt System Testing Training United States National Institutes of Health Update Youth arm cisgender density digital digital platform effectiveness testing effectiveness/implementation study effectiveness/implementation trial empowerment evidence base experience experimental study family support gender affirming care gender affirming therapy gender diversity health determinants health disparity health disparity populations health equity health inequalities high risk hormone therapy implementation evaluation improved innovation insight minority stress multiphase optimization strategy peer pilot test primary outcome programs provider networks psychological distress public health relevance racial diversity racial minority reducing suicide resilience factor response secondary outcome sex assigned at birth simulation social social determinants social health determinants social stigma structural determinants structural health determinants suicidal suicidal risk suicide rate systemic intervention transgender treatment as usual treatment effect

项目摘要

Revised Abstract Transgender and gender diverse (TGD) youth (ages 15-24), with gender identities differing from their sex assigned at birth, are a growing NIH-designated health disparities population. TGD youth suffer higher rates of suicide than their cisgender counterparts; over half contemplate suicide in their lifetime. These and other health disparities are compounded for TGD youth who are Black or Hispanic and experience both gender- and racebased stigma and minority stress. Black adolescents are also at an increased risk of suicide; attempts increased 73% from 1991 to 2017. Interventions are needed urgently to improve the mental health of TGD youth, particularly TGD youth who are also racial minorities. We propose a transformative, multi-level intervention to advance equity and reduce health disparities for TGD youth through individual, interpersonal, systemic, and community-based changes that increase knowledge and support among providers, youth, and caregivers, thereby reducing suicidality and improving mental health. Provider and family/caregiver support are known to be critical determinants of mental health outcomes for TGD youth, yet no large-scale interventions exist to address these remediable structural and social determinants of health. Our intervention has two components. The first is a provider training and support program. This entails a free online training course for continuing education credit that teaches providers how to support and communicate effectively with TGD patients and a provider network for increasing psychosocial support. The second is an interactive educational digital platform for TGD youth and caregivers. The digital platform provides expert-generated knowledge via educational modules and uses interactive features to promote communication and strengthen relationships between youth and caregivers. We will use a Multiphase Optimization Strategy (MOST) framework to optimize the platform for testing in a hybrid effectiveness-implementation trial with an Immediate Arm (upfront access) and Deferred Arm (access at 6 months). The intervention period for each Arm will last 6 months, followed by an observation period of up to 12 months with continued access. Using validated subscales, we will assess changes in the proportion of individuals reporting suicidal ideation in the prior three months (primary outcome) and in psychological distress and anxiety, caregiver support, and health care empowerment (secondary outcomes), as well as dose effects, heterogeneity of treatment effects across groups, and within- group resilience factors. This innovative, multi-level intervention fulfills a significant unmet need for near-term and sustainable solutions to the health disparities faced by TGD youth and addresses intersecting forms of stigma and inequity to transform mental health outcomes for a highly vulnerable, at-risk youth population.

修订摘要跨性别和性别多样性（TGD）青年（15-24岁），性别认同与出生时分配的性别不同，是一个不断增长的NIH指定的健康差异人群。TGD青年的自杀率高于顺性别青年;超过一半的人在一生中考虑过自杀。对于黑人或西班牙裔的TGD青年来说，这些和其他健康差距更加复杂，他们经历了基于性别和种族的耻辱和少数民族压力。黑人青少年自杀的风险也在增加;从1991年到2017年，尝试自杀的人数增加了73%。迫切需要采取干预措施，以改善TGD青年的心理健康，特别是TGD青年谁也是少数民族。我们提出了一个变革性的，多层次的干预，以促进公平和减少健康差距的TGD青年通过个人，人际，系统性和以社区为基础的改变，增加提供者、青年和照顾者的知识和支持，从而减少自杀行为并改善心理健康。提供者和家庭/照顾者的支持是TGD青年心理健康结果的关键决定因素，但没有大规模的干预措施来解决这些可补救的结构和社会健康决定因素。我们的干预有两个组成部分。第一个是供应商培训和支持计划。这需要一个免费的继续教育信贷在线培训课程，教导供应商如何支持和有效地与TGD患者和供应商网络进行沟通，以增加心理社会支持。第二个是为TGD青年和照顾者提供的互动教育数字平台。该数字平台通过教育模块提供专家生成的知识，并利用互动功能促进沟通，加强青年与照顾者之间的关系。我们将使用多阶段优化策略（MOST）框架来优化平台，以便在混合有效性-实施试验中进行测试，包括即时组（前期访问）和延迟组（6个月访问）。每组的干预期将持续6个月，随后是长达12个月的观察期，并继续使用。使用经验证的子量表，我们将评估前三个月内报告自杀意念的个体比例（主要结局）和心理困扰和焦虑，护理人员支持和医疗保健授权（次要结局）的变化，以及剂量效应，各组治疗效应的异质性和组内弹性因素。这种创新的多层次干预措施满足了TGD青年面临的短期和可持续解决健康差距的重大未满足需求，并解决了交叉形式的耻辱和不平等，以改变高度脆弱，高危青年人口的心理健康结果。