Virtual Journal Club – Note From the Editor-in-Chief [of the AJPH]: Who Wants to Exclude Older LGBT Persons From Public Health Surveillance?

Squeezing in a fourth article before the Nursing Summit on September 13.  Here is the citation information to get started:

Morabia, A. (2017). Note From the Editor-in-Chief: Who Wants to Exclude Older LGBT Persons From Public Health Surveillance?. American Journal of Public Health 107(6), pp. 844–845. Retrieved September 1, 2017 from http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.303851.

This editorial examines several concerns around both the decision to remove a demographic question on sexual orientation from the National Survey of Older Americans Act Participants and the rationale given for doing so.  Morabia particularly takes a look at the methodology used to survey rare groups (and the lack of understanding that this decision showed) as well as the importance of doing so to ensure the health of these groups is given consideration in developing policy and allocating resources.  (This decision was reversed in June of this year.)

What are your thoughts on this editorial?  Do you feel that it balances concerns around health equity with concerns around methodology and whether the decision-makers understood it?  What might you have said/done differently if you were to write a similar opinion piece?

Those are just some starter questions.  Please don’t let them limit you!

Also, please suggest any articles you would like to discuss here.  It’s helpful if they’re freely available online, but that’s not an absolute requirement.

Virtual Journal Club – Delivering Culturally Sensitive Care to LGBTQI Patients

Our third Virtual Journal Club article is by another GLMA Nursing section member, Jessica Landry.  Here is the citation information:

Landry, J. (2017). Delivering culturally sensitive care to LGBTQI patients. The Journal for Nurse Practitioners, 13(5), 342-347. Retrieved August 3, 2017 from http://www.npjournal.org/article/S1555-4155(16)30828-5/fulltext .

This article gives what I imagine many reading this blog would consider very basic guidelines for providing culturally sensitive care to LGBTQI patients, which makes sense as it is published in a journal aimed towards nurse practitioners in general.  It also covers a lot of ground, including an overview of health disparities and barriers to care as well as a glossary of terms, a vignette to illustrate some of the challenges, and some suggestions on how to handle certain situations.

What are your thoughts?  Are there elements of this article you think would be particularly helpful in educating fellow nurses?  Are there elements you think you’d prefer to address differently?  Did this give you an idea for submitting a follow-up article of your own, perhaps, to continue the conversation?  Please comment with whatever thoughts you care to share.

Also, the articles chosen so far have come from a biweekly report I receive from EBSCO about new articles on LGBT health.  These are just the ones that happened to jump out at me for one reason or another, though.  If you have come across an article you’d like to see discussed here (or have written one!), please share that in the comments as well.

 

Virtual Journal Club – A grounded theory of bisexual individuals’ experiences of help seeking

For our second virtual journal club “meeting,” I chose the following article.  Unfortunately, what I do not have is a live link for this one.  I’m hoping that many here will have access through their academic or clinical institutions.

MacKay, J., Robinson, M., Pinder, S., & Ross, L. E. (2017). A grounded theory of bisexual individuals’ experiences of help seeking. American Journal Of Orthopsychiatry87(1), 52-61. doi:10.1037/ort0000184

As any work using grounded theory would, this has a lot to dig our teeth into!  I’ll give a bit of a summary here for those not able to access the full article.

The authors start with a discussion of mental health disparities of bisexual-identified individuals as compared with both heterosexual- and gay- or lesbian-identified individuals.  While acknowledging that the data are not as robust as might be ideal, the authors feel confident that this population’s experiences are distinct enough to merit exploration.  The authors also expressed a hope that, while the population chosen was bisexual people, that this could serve as a more general case study of help-seeking by a group impacted by minority stress (p. 52).

In their breakdown of participant demographics, the authors note that the orientation identities covered include, bisexual, fluid, pansexual, queer, and two-spirited (p. 54, table 1).  It’s interesting to note that while 20% of participants identified as First Nations, only 10% identified as two-spirited, an identity specific to First Nations and Native American people.

The authors framed help-seeking as a process, with the stages being “Consideration of Services,” “Finding Services,” and “Accessing Services” (pp. 55-56).  They then went on to analyze themes that emerged around factors that influenced participants’ choices and actions during these stages.

Many of the barriers to access discussed were general, such as the fact that non-biomedical care (i.e. therapy other than medication) required out-of-pocket payment and that the overall Mental Health Services (MHS) in Canada tend to treat medication as first-line treatment.  Finding practitioners with positive and accepting attitudes towards lesbian, gay, and bisexual (LGB) people was also identified as a barrier.  More bisexual-specific barriers included history of poor experiences with providers around their identity such as being told bisexuality does not exist (p. 56).

Facilitators to access also emerged, such as socioeconomic privilege, self-advocacy, and the existence of some resources specifically for locating affirming practitioners (pp. 57-58).  Unfortunately, these facilitators for some imply some of the same barriers for others (finances, availability of information on which practitioners are bisexual-accepting).

The authors acknowledge that negative anecdotes were prevalent in their findings.  For example, they note that the financial barriers led to delaying care until the symptoms being experienced became urgent.  They also noted the importance of social networks in facilitating locating LGB-positive providers.  Many participants reported their first experiences with MHS had been at university, where care was freely available, and the authors include in their implications a recommendation that Ontario MHS look at replicating that model to facilitate wider access (pp. 59-60).

Another implication and recommendation that will surprise no one here is to improve the curricula of mental health providers.  One sentence here stuck out to me in particular:  “It is important for service providers, even those that are affirming of nonheteronormative relationships, to be competent at working with individuals whose experiences and identities are difficult to categorize in binary terms” (p. 60).  In the previous article discussed, the focus was on people whose gender identity does not fit into “neat” binary categories.  Selecting these two articles back-to-back as both focusing on non-binary identities wasn’t planned, but is a happy coincidence.

What are your thoughts?  Do you find the process model of help-seeking the authors used to be helpful, or would you have taken a different approach?  What do you think of their idea that this (or any) specific minority group could be seen as a case study for minority groups in general?  What would you think are the key take-aways for nurses whose primary practice area is mental health, whether in Ontario where the study was or elsewhere?

Virtual Journal Club – Gender queer: Politics is killing us

One thing we’ve decided to try is to have a virtual journal club in which we discuss an article related to LGBTQ health, and for our first article, it seemed like a good idea to start with this article by Laura C. Hein and Mary F. Cox.  The topic is timely, and the lead author is a member of our section!

To make it easier for you to find the article, here is the reference information at the beginning, rather than at the end:

Hein, L.C., and Cox, M.F. (2017). Gender queer: politics may be the death of us. Nursing Inquiry, 24, e12181. Retrieved July 6, 2017 from http://onlinelibrary.wiley.com/doi/10.1111/nin.12181/pdf .

This invited commentary opens with a discussion of what it means to be transgender or gender non-conforming as well as some data on non-binary identities.  The studies cited show that those who identify as genderqueer or would fall under the umbrella of non-binary gender identity are a much larger percentage (36-70%) of the transgender population than many may think (para 1).  A discussion of the impact of the 2016 presidential election on anti-LGBTQ hate crimes (80 incidents in the week following the election) highlights the importance of understanding the political context and its effects on LGBTQ lives (para 2).  Further, a connection is made between not fitting “neatly” into M/F gender boxes and risk for violence.

What are your thoughts? Do you work in a clinical area such as an emergency room where you are able to observe trends in violence? Does your organization recognize non-binary gender identities in the care setting?  In the health record? How can we not only ensure our patients’ dignity and safety but also capture data when their safety has been violated, so that their experiences can be addressed rather than erased?

Please discuss in the comments!

 

 

Working Towards LGBTQ Health Equity

In health care, we inherently understand that care must be tailored to individuals, as patients have different needs. For example, if a patient walks in with an ear infection and another patient comes in with a broken arm, we treat each patient differently, according to their needs, in order to provide the best care possible.

For some reason this logic fails us when we are working with patients across marginalized identities, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. This, mostly unconscious, bias in favor of majority identities perpetuates health disparities. For example, LGBTQ individuals are “significantly less likely than others to have health insurance, are more likely to report unmet health needs, and, for women, are less likely to have had a recent mammogram or Papanicolaou test.”

When training health professionals, I’ve heard folks at various levels (medical assistants, nurses, providers, etc.) say that they don’t need training on LGBTQ patient care, because they treat all patients “equally.” Yet this equality framework fails to acknowledge that LGBTQ patients have different needs than cisgender and straight patients and that we cannot provide excellent care without adjusting appropriately.

Instead of continuing to use the equality framework, I propose we utilize a health equity approach to care, which simply means that we tailor our care to our patients needs. Equitable care is provided when we adjust our care appropriately so LGBTQ individuals have equal outcomes compared to their straight/heterosexual and cisgender counterparts.

IISC_EqualityEquity

Image credit: Interaction Institute for Social Change

Learn more about the fascinating history of this image here!

How can we improve health equity for LGBTQ patients?

Providing equitable care for LGBTQ individuals means health care professionals need to know who their patients are, how they identify, who their support systems are, and how their relationships and identities impact their well-being.

As a health professional, the only way to improve care for LGBTQ patients is to understand how their lived experiences differ from straight and cisgender patients. LGBTQ identity/ies can impact:

  • Access to Care
  • Preventative Services
  • Family Building
  • Relationships
  • Family Support
  • Safety (Intimate Partner Violence and Domestic Violence)
  • Work
  • HIV Exposure
  • and more!

The first step towards providing equitable care for your LGBTQ patients is to simply identify who they are. Here are a few ways you can identify LGBTQ patients and make them feel safe and comfortable in clinical spaces.

Don’t assume the name in the chart is the name your patient wants you to use.

Your initial introduction can make or break the entire encounter. Transgender and gender non-binary patients in particular will take note if you make assumptions about their name and/or pronouns, as electronic medical records may or may not align with the name they use and their gender.

Here’s an example of an inclusive introduction:

You: “Hi, I’m [insert your name] and I will be working with you today. How would you like me to address you today?”

Patient: “Hi, [your name].  Please call me [patient’s name].”

You: “Lovely to meet you, [insert patient’s name here]. What pronouns do you use? For example, I use [insert your pronouns, ex: she/her].”

Do ask about sexual orientation and gender identity (SOGI).

The only way to find out who your LGBTQ patients are is to ask.

In addition to typical medical and social health history questions, ask every patient the following:

  • “How do you identify your sexual orientation?”
  • “What was your sex assigned at birth?”
  • “What is your gender/gender identity?”

If your straight and/or cisgender patients are uncomfortable with these questions, take a teaching moment to share why these are important questions for all patients.

Trust your patients and learn from them.

Our patients know themselves and their lives best. Believe what they tell you and take the time to learn about their identities and their health care needs between visits. Self-reflection and cultural humility are critical skills when working with all patient populations. Remember that working towards equitable and inclusive care is an ongoing process, so be patient with yourself and expect to make mistakes as you learn.

I have an LGBTQ patient! Now what do I do?

Great question! The next step in providing equitable care is to critically assess how your patient’s identity/identities impact their health needs.

Keep following this series and the GLMA Nursing blog to learn more about how to assess your patients’ needs and improve your clinical management of LGBTQ individuals.

Can’t wait? Check out GLMA’s archived webinars to learn more about providing LGBTQ-inclusive care.


CookTiffanyETiffany E. Cook is the Training and Professional Development Program Coordinator at NYU School of Medicine’s Office of Diversity Affairs. She received her undergraduate degree in General Studies with a minor in Women’s and Gender Studies from the University of Idaho and is currently applying to nursing school with plans to become a Family Nurse Practitioner. She serves on the GLMA Nursing Section’s Web Team and can be found on Twitter at @TiffanyECook.

 

Lesbian Health Fund Research Grants due May 1

Reminder:
Lesbian Health Fund
Call for Abstract Submissions

Deadline: May 1, 2017

The Lesbian Health Fund (LHF), a program of GLMA, has its next grant cycle planned for Spring 2017. In honor of the victims of the Orlando shooting, this cycle will give preference to funding research focused on societal and domestic violence affecting sexual minority women or girls.

LHF is currently accepting proposals for research through May 1, 2017.

About LHF

Founded in 1992, the LHF has awarded more than $860,000 to fund 110 research grants on lesbian health, and is the only US research fund dedicated solely to the unique health needs of lesbians, other sexual minority women (SMW) and their families.

Today, LHF remains committed to improving the health of lesbians and other sexual minority women over the lifespan, from early childhood, through adolescence, and adulthood, including aging. There is still great need to understand how social determinants, especially race and ethnicity, influence the health and wellbeing of lesbians, other SMW and their families.

Priority Research Areas:

  • Understanding social, family and interpersonal influences as sources of stress or support
  • Eliminating inequalities in health care, including barriers to care, and improving quality of care and utilization rates
  • Development and testing of interventions to address mental and physical health needs of lesbians and other SMW, including but not limited to depression, identity related issues, eating disorders, substance abuse, obesity, cancer risks, cardiovascular disease and sexually transmitted infections
  • Sexual and reproductive health, including family & parenting issues

Many applications are for small projects ($10,000 – $20,000) structured to provide pilot data for subsequent research. Publication in a peer-reviewed journal is expected, and priority is given to the best proposals with the greatest likelihood of securing future funding from other sources.

Proposals for the fall grant cycle are due on May 1st, 2017 at 11:59pm EST.  Click herefor information on how to apply.  Click here for a list of previously funded grants.

Please forward this announcement to anyone who might be interested.  GLMA Board Members and LHF Advisory Committee Members or paid consultants are ineligible to submit grants.  Please contact us at lhf@glma.org, or 202-600-8037, ext. 304 with any questions.

 

The Worth (and Work) of Networking

The concept of networking can seem obscure or even daunting at first. Jessica Marsack is a PhD student with the School of Nursing and Center for Sexuality and Health Disparities at the University of Michigan. She explains (with tips) that once you get started, the time you put in to networking leads to valuable rewards.


As a new (and current) graduate student I was often told to go to conferences, not only to learn about the newest research, but also to “network”. While this is a commonly used phrase, I find it is less commonly explained. There are certainly prescribed avenues for networking at conferences, such as meet and greet sessions or “speed dating” activities. However, I don’t believe networking has to be a formal encounter. While attending the 2016 conference of the Gay and Lesbian Medical Association (GLMA), I informally asked if Dr. Peggy Chinn, one of the nursing summit leaders, would like to have dinner and chat about the conference. She agreed, and this actually turned into a dinner with the entire GLMA nursing section leadership board. At this dinner I learned about the opportunity to become a student representative on the GLMA nursing section leadership team, and eagerly accepted an invitation to join. As a student representative I have been involved in the behind the scenes work of a national organization, and learned new skills such as website design and conference planning considerations- none of which would have been possible without that initial networking opportunity.

“I don’t believe networking has to be a formal encounter. While attending the 2016 conference of the Gay and Lesbian Medical Association (GLMA), I informally asked if Dr. Peggy Chinn, one of the nursing summit leaders, would like to have dinner and chat about the conference. She agreed, and this actually turned into a dinner with the entire GLMA nursing section leadership board”

Networking may seem intimidating to some- especially graduate students, who often suffer from “imposter syndrome”. Being surrounded by big names within the scientific community can be intimidating, and it may feel like you aren’t important enough for their time or attention. However, my experiences have been overwhelmingly positive. Scientific conferences are designed for people to discuss and share their work, so even the “big names” in your field are expecting people to engage them in discussion. Everyone I’ve networked with at conferences has been friendly and open to conversation, and suggested avenues for research or posed questions I had not considered. In this way, networking can provide opportunities for bettering yourself and your research. Your networking can also turn into new skills and opportunities that might not arise any other way.

“My experiences have been overwhelmingly positive. Scientific conferences are designed for people to discuss and share their work, so even the “big names” in your field are expecting people to engage them in discussion.”

If you’re feeling nervous, it can help to pick something concrete to start a conversation about. Ask a specific question about a poster presentation or talk your person of interest presented. If that question relates to your research, you can segue into talking about your work if that is your goal. If they aren’t presenting anything, simply asking people about their newest project or future research interests generally catches the focus of fellow scientific minds. These informal networking techniques can lead to new possibilities you may not achieve through other means. As intimidating as it may seem, both you and your research will benefit in the end- and you are worth it.

GLMA Mixer in San Francisco, March 10

BAPHR & GLMA Joint Mixer
San Francisco, CA
Friday, March 10, 2017
6:30pm – 8:30pm PST

We invite you to join us for a joint reception with Bay Area Physicians for Human Rights and GLMA: Health Professionals Advancing LGBT Equality! Meet your colleagues and learn more about our work to improve the health and well-being of LGBT people!

Lookout Bar SF
3600 16th Street
(at Market Street)
San Francisco, CA 94114

Light appetizers will be provided.
BAPHR and GLMA members will also receive a drink ticket.

To RSVP, please email info@glma.org and be sure to include your name, credentials, email, and the names of any guests who will be attending.

See you on March 10, 2017 at Lookout Bar SF!

Lesbian Health Fund Call for Abstracts

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Lesbian Health Fund
Call for Abstract Submissions
Deadline: May 1, 2017

The Lesbian Health Fund (LHF), a program of GLMA, has its next grant cycle planned for Spring 2017. In honor of the victims of the Orlando shooting, this cycle will give preference to funding research focused on societal and domestic violence affecting sexual minority women or girls.

LHF is currently accepting proposals for research through May 1, 2017.

About LHF

Founded in 1992, the LHF has awarded more than $860,000 to fund 110 research grants on lesbian health, and is the only US research fund dedicated solely to the unique health needs of lesbians, other sexual minority women (SMW) and their families.

Today, LHF remains committed to improving the health of lesbians and other sexual minority women over the lifespan, from early childhood, through adolescence, and adulthood, including aging. There is still great need to understand how social determinants, especially race and ethnicity, influence the health and wellbeing of lesbians, other SMW and their families.

Priority Research Areas:

  • Understanding social, family and interpersonal influences as sources of stress or support
  • Eliminating inequalities in health care, including barriers to care, and improving quality of care and utilization rates
  • Development and testing of interventions to address mental and physical health needs of lesbians and other SMW, including but not limited to depression, identity related issues, eating disorders, substance abuse, obesity, cancer risks, cardiovascular disease and sexually transmitted infections
  • Sexual and reproductive health, including family & parenting issues

Many applications are for small projects ($10,000 – $20,000) structured to provide pilot data for subsequent research. Publication in a peer-reviewed journal is expected, and priority is given to the best proposals with the greatest likelihood of securing future funding from other sources.

Proposals for the Spring 2017 grant cycle are due on May 1st, 2017 at 11:59pm EST. Click here for information on how to apply.  Click here for a list of previously funded grants.

Please forward this announcement to anyone who might be interested.  GLMA Board Members and LHF Advisory Committee Members or paid consultants are ineligible to submit grants.  Please contact us at lhf@glma.org, or 202-600-8037, ext. 304 with any questions.