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Assessing Health Provider Perspectiv...

Angelino, Alessandra.

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Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare./
作者:	Angelino, Alessandra.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2019,
面頁冊數:	35 p.
附註:	Source: Masters Abstracts International, Volume: 81-04.
Contained By:	Masters Abstracts International81-04.
標題:	Public health. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=13897854
ISBN:	9781088329764

Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare.
Angelino, Alessandra.

Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare. - Ann Arbor : ProQuest Dissertations & Theses, 2019 - 35 p.

Source: Masters Abstracts International, Volume: 81-04.

Thesis (M.P.H.)--University of Washington, 2019.

This item must not be sold to any third party vendors.

Background: American Indian/Alaska Native (AI/AN) youth disproportionately face barriers accessing healthcare when compared to non-AI/AN youth. Additionally, youth who identify as both AI/AN and transgender or Two-Spirit face higher rates of mental health issues and suicidality, along with increased rates of non-communicable and communicable disease. These disparities primarily result from severe health inequity and historical trauma. There is therefore a need to assess what barriers exist among AI/AN transgender and Two-Spirit youth. Understanding both provider and patient-side barriers in this vulnerable population has implications for improving patient care and reducing health disparities for AI/AN transgender and Two-Spirit youth.Objectives: This project evaluated health provider knowledge of LGBTQ2S health and historical context surrounding gender identity in AI/AN communities. It assessed provider perspectives of provider-side and patient-side barriers accessing care, in order to gain insight and develop suggestions for improvement. Provider type, clinic affiliation, and clinic location were also evaluated to determine impact on provider perspectives.Methods: Semi-structured interviews (SSI) and focus group discussions (FGD) were held among providers affiliated with three reservation-based tribal health centers and a non-tribal tertiary children's hospital in the Pacific Northwest. The question guide used was developed using a community-based participatory research conceptual model, considering the impact of context, partnerships, and community knowledge on barriers to care and provider perspectives. SSI and FGD lasted for 30-60 minutes, were audio-recorded, and transcribed verbatim. All providers cared for AI/AN youth ( ≤ 18 years) who identify as transgender or Two-Spirit. SSI and FGD were analyzed using a grounded theory approach to understand barriers and themes. This project received exemption from the University of Washington IRB and approval from each tribal ethical and/or research committee.Results: Twenty healthcare providers participated in this study and represented a number of geographic settings, provider types, and ethnic backgrounds. Participant knowledge regarding LGBTQ2S health and historical context surrounding gender in Native communities varied, although participants felt their understanding and comfort was limited. The long-standing effects of settler colonialism, trauma, and systemic issues such as marginalization and an antiquated medical system presented as overarching concepts. Participants also presented a number of patient-side and provider-side barriers impacting access to care for these patients, and suggested solutions to reduce these barriers at the provider, patient, and systemic levels. Geography, and occasionally provider type, appear to influence barriers and the solutions provided.Conclusions: A number of patient and provider-side barriers inhibit AI/AN transgender and Two-Spirit youth access to healthcare. It is evident that historical trauma and community resilience play a role in health and healthcare for these youth. Understanding this history, the intersection of identities, and inherent community strengths can help with the development and implementation of solutions to provide high quality care to AI/AN transgender or Two-Spirit youth.

ISBN: 9781088329764Subjects--Topical Terms:

534748
Public health.

Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare.
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520 $a Background: American Indian/Alaska Native (AI/AN) youth disproportionately face barriers accessing healthcare when compared to non-AI/AN youth. Additionally, youth who identify as both AI/AN and transgender or Two-Spirit face higher rates of mental health issues and suicidality, along with increased rates of non-communicable and communicable disease. These disparities primarily result from severe health inequity and historical trauma. There is therefore a need to assess what barriers exist among AI/AN transgender and Two-Spirit youth. Understanding both provider and patient-side barriers in this vulnerable population has implications for improving patient care and reducing health disparities for AI/AN transgender and Two-Spirit youth.Objectives: This project evaluated health provider knowledge of LGBTQ2S health and historical context surrounding gender identity in AI/AN communities. It assessed provider perspectives of provider-side and patient-side barriers accessing care, in order to gain insight and develop suggestions for improvement. Provider type, clinic affiliation, and clinic location were also evaluated to determine impact on provider perspectives.Methods: Semi-structured interviews (SSI) and focus group discussions (FGD) were held among providers affiliated with three reservation-based tribal health centers and a non-tribal tertiary children's hospital in the Pacific Northwest. The question guide used was developed using a community-based participatory research conceptual model, considering the impact of context, partnerships, and community knowledge on barriers to care and provider perspectives. SSI and FGD lasted for 30-60 minutes, were audio-recorded, and transcribed verbatim. All providers cared for AI/AN youth ( ≤ 18 years) who identify as transgender or Two-Spirit. SSI and FGD were analyzed using a grounded theory approach to understand barriers and themes. This project received exemption from the University of Washington IRB and approval from each tribal ethical and/or research committee.Results: Twenty healthcare providers participated in this study and represented a number of geographic settings, provider types, and ethnic backgrounds. Participant knowledge regarding LGBTQ2S health and historical context surrounding gender in Native communities varied, although participants felt their understanding and comfort was limited. The long-standing effects of settler colonialism, trauma, and systemic issues such as marginalization and an antiquated medical system presented as overarching concepts. Participants also presented a number of patient-side and provider-side barriers impacting access to care for these patients, and suggested solutions to reduce these barriers at the provider, patient, and systemic levels. Geography, and occasionally provider type, appear to influence barriers and the solutions provided.Conclusions: A number of patient and provider-side barriers inhibit AI/AN transgender and Two-Spirit youth access to healthcare. It is evident that historical trauma and community resilience play a role in health and healthcare for these youth. Understanding this history, the intersection of identities, and inherent community strengths can help with the development and implementation of solutions to provide high quality care to AI/AN transgender or Two-Spirit youth.
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