A Feasibility Study of a Telehealth Intervention on Health Care Service Utilization among Transgender Women of Color in Washington, DC

Abstract

Background Transgender women of color (TWC) are a medically underserved population who often experience substantial barriers to care. TWC experience high rates of stigma, violence, and entrenched barriers to receiving routine or specialty health services. Novel ways to improve access for TWC are urgently needed. Telehealth is one way to support TWC in overcoming barriers, yet this approach has been largely unexamined. The purpose of this study was to develop a TWC-specific telehealth intervention to increase access to primary and specialty care and then pilot test this intervention in a sample of TWC with at least one structural barrier to care. Methods Eligible participants were 18 years or older, identified as male sex at birth with a current gender identity of either female or transgender, a member of a racial/ethnic minority, and had experienced at least one study-defined structural barrier to primary or specialty care in the past 6 months. Following a 3-month preintervention phase, participants began a 3-month telehealth intervention which provided secure, remote access to trained, culturally appropriate, peer health consultants (PHCs) via video chat, e-mail, text, or phone. Health care utilization was assessed monthly via computer-assisted self-interview. Outcomes of intention to seek care in the next month and receipt of care in the past month were modeled using generalized estimating equations (GEE). Results Twenty-five eligible participants were enrolled in the study; a majority were black (96%), older than 25 years (69%), living with human immunodeficiency virus (HIV) (52%), and reported depressive symptomatology (67%). Of the 16 who had at least one pre- and one intervention data collection point, 13 downloaded the mobile video chat application and 7 participated in a qualitative exit interview. The intervention was associated with significantly (p < 0.05) increased odds of intention to seek transgender-specific care (adjusted odds ratio, aOR: 1.76 [95% confidence interval, CI: 1.001–3.08]); participants with depression defined by an elevated Center for Epidemiologic Studies 8-item depression scale (CES-D-8) score were significantly more likely to have intention to seek specialty care (aOR: 10.53 [95% CI: 1.42–77.97]), HIV-specific care (aOR: 2.56 [95% CI: 1.27–5.17]), and mental health care (aOR: 2.56 [95% CI: 1.27–5.17]) during the intervention period. Participants with elevated CES-D-8 scores had significantly greater odds of having sought HIV-specific care (aOR: 2.31 [95% CI: 1.31–4.06]) during the intervention period relative to those with lower scores. Conclusion These pilot data suggest that telehealth with remote access to PHCs who can provide immediate, culturally competent, nonclinical, education, and referral guidance may be effective in overcoming multiple barriers and improving care utilization outcomes for TWC. Telehealth may be an innovative, low-cost solution to improve health outcomes for populations with multiple barriers to health care services.

Development of a telehealth intervention to promote care‐seeking among transgender women of color in Washington, DC

“…As a result of this formative work, we developed, implemented, and evaluated a novel telehealth intervention among 25 TWC in a pre–post design. Following the formative phase described in this paper, we demonstrated in a pilot study that the resulting intervention based on this qualitative work was associated with improvements in intention to seek care and actual care sought by TWC, particularly for those TWC experiencing mental health challenges (Magnus et al, ). Our findings suggest that this culturally tailored telehealth intervention may be able to improve health care utilization.…”

“…Our findings regarding Individual, Organizational, and Environmental barriers were consistent with findings from previous studies looking at health care engagement for the transgender population (Adelson et al, ; Ayala & Ibanez, ; Baral et al, ; Bradford et al, ; Brennan et al, ; Bry et al, ; Cicero et al, ; Eaton, Kalichman, et al, ; Eaton, Matthews, et al, ; Frank et al, ; Garofalo et al, ; Jin et al, ; Kussin‐Shoptaw et al, ; MacCarthy et al, ; Poteat et al, ; Reisner et al, ; Siembida et al, ) and are helpful in leveraging technology and telemedicine approaches to better serve TWC. Upon completion of the formative data collection, several day‐long meetings with study faculty and staff and key TWC stakeholders were convened to discuss the findings and propose the intervention, which was subsequently evaluated in a pre–post test pilot study (Magnus et al, ).…”

“…Following the formative phase described in this paper, we demonstrated in a pilot study that the resulting intervention based on this qualitative work was associated with improvements in intention to seek care and actual care sought by TWC, particularly for those TWC experiencing mental health challenges (Magnus et al, 2018).…”

“…are helpful in leveraging technology and telemedicine approaches to better serve TWC. Upon completion of the formative data collection, several day-long meetings with study faculty and staff and key TWC stakeholders were convened to discuss the findings and propose the intervention, which was subsequently evaluated in a pre-post test pilot study (Magnus et al, 2018).…”

Considerations for Providing Pediatric Gender-Affirmative Care During the COVID-19 Pandemic

“…As interdisciplinary professionals working with gender diverse youth, it is crucial that we continue to provide access to gender-affirming care (GAC) during the COVID-19 pandemic. Before the pandemic, telemedicine was an effective delivery method of mental health services and consultation in GAC, particularly for those living in more rural areas, and has been successfully used for gender diverse adolescents [ [1] , [2] , [3] , [4] ]. While professionals may find that the guidelines and laws of their respective state licensing and regulatory boards (e.g., practicing telemedicine across state lines) vary, it is imperative to overcome these challenges to provide continuity in care to support transgender and nonconforming youth during this time.…”