They included a desire for an LGB-provider/venue, or a provider of a particular gender, to no concern at all as long as the provider was comfortable with the patient’s sexuality. Expertise was also a priority and providers were frequently selected based on their specific skills. Barriers in access Cultural differences Cultural competence in healthcare is the ability to provide care to people from diverse backgrounds and adapting or designing that care to meet their social, cultural, and linguistic needs (Health Research and Educational Trust, 2013). To achieve cultural competence in healthcare systems, there must be policies in place along with training and education to change behaviors at the systems and personal levels. For systems, there may be the provision of language assistance or a cultural specialist that is part of the care team and interacts in the community. Benefits to these changes are social, such as promoting inclusion, increasing community participation in their health, and increased trust. Health benefits include improved preventive care, fewer missed appointments, and reduced disparity. The resulting benefits then lead to business benefits such as more efficient care, closer to meeting guideline recommendations, and increased market share (Health Research & Educational Trust, 2013). There are several stages in cultural competency: blindness (ignorance), awareness (you know you do not know), knowledge (you see differences and accept the person and their beliefs), and skills (gain ability to interact with different Treatment recommendations McNair and Hegarty (2010) conducted a systematic review on primary care guidelines, available in several countries including the US, for LGB people, to determine if they met the Appraisal of Guidelines Research & Evaluation Instrument (AGREE) criteria for quality. The AGREE instrument is a framework for assessing the quality of development for clinical practice guidelines for potential bias, validity, and feasibility for practice. AGREE does not assess a guideline’s impact on patient outcomes, but looks at “the methods of development, the content used to develop and the content of final recommendations” (AGREE Consortium, 2013). McNair and Hegarty (2010) found that, although the available guidelines are consistent philosophically and practically, they did not meet all criteria for rigorous development, dissemination, or were not specific for primary care. GLMA (2006) developed guidelines to guide the healthcare of LGBTQ people. This course has discussed some of the general recommendations for creating a welcoming, nonjudgmental environment and incorporating intake and sexual history forms that provide more inclusive and open-ended questions. GLMA recommends discussing patient confidentiality and developing a written statement to explain how their information is protected, how it remains confidential, who can access it, and what circumstances may require sharing of information. The preventive care topics are no different than for any client and, as always, we must take the time to determine which is a specific risk for each patient. Each new patient visit should assess sexual risk, safety related to lifestyle (seatbelts, firearms, sunblock), domestic violence, and substance use. As many as 45% of lesbian and bisexual women are not out to their providers, which reinforces the need to obtain a nonjudgmental sexual history and reinforcing confidentiality. GLMA identify risk factors for lesbian and bisexual women as being primarily social and behavioral. These include stress and failure to seek care, being overweight, as well
to healthcare were varied by age groups and insurance coverage. A frustration for many was the additional cost for utilization of a provider outside the network or the compromise between preferences such as skill set or “queer friendly” (Martos et al., 2018, p. 10). cultures; Martin & Vaughn, 2021). Cultural competence develops in stages with individuals moving through stages at various rates with the assistance of education, training, commitment, and practice (Martin & Vaughn, 2021). While cultural competency training can be beneficial, there is a concern of forming assumptions and stereotypes (Sprik & Gentile, 2020) and no one person manifests all expectations of their culture. Cultural humility involves a personal commitment to self- evaluation and critique to focus on improving relationships (Sprik & Gentile, 2020). The benefit to cultural humility is a focus on individuals, getting to know a person’s health goals, fears, and expectations, allowing for person-centered care. Cultural humility also calls for self-reflection of one’s thoughts and biases, allowing for an equal provider-patient relationship and not requiring specific courses. Regardless of the method, identification of one’s feeling as they encounter someone with a different lifestyle or experiences is important in both cultural competence and humility. as smoking and substance use. Completing screening for substance use, interpersonal violence, depression, and anxiety are important to identify these possible risks. Consideration should be given for breast cancer screening at age 40 in women who have not had children or experienced early menarche, and in those with a positive family history. Do not assume a lesbian or bisexual woman does not plan to have children. Pap smears should be completed on all individuals with a uterus, including HPV testing at the recommended intervals, since transmission of HPV can occur among WSW. Additional screening and health concerns should be age appropriate and focused on actual behaviors of each client. Gay and bisexual men should receive the same screenings as any male (i.e., colon, prostate, and testicular cancers; coronary artery disease) with consideration for the increased risk of anal HPV, anal cancer, domestic violence, mental health issues, and substance use (GLMA, 2006). Healthcare for transgender individuals has been lacking in much of the US because of the insufficient number of healthcare providers with adequate training, discrimination or negative behaviors experienced during healthcare utilization, and insufficient insurance or ability to pay for care (Lerner & Robles, 2017; Nurse Practitioners in Women’s Health [NPWH], 2018). Screening should be based on anatomy and behaviors that are present. Cervical and prostate screenings, for anyone with a cervix or prostate respectively, should be conducted at recommended intervals for trans and cisgender individuals. Transgender men may experience anxiety or distress during pelvic examinations, and healthcare providers should be sensitive to this and attempt to maximize comfort during the examination (NPWH, 2018). Likewise, mammography is recommended for transmen who have not undergone chest reconstruction. Desire for birth control and fertility should also be discussed without assumptions by the provider (NPWH, 2018).
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Book Code: SWTX1525
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