Transphobia rather than education predicts provider knowledge of transgender health care

Abstract

Purpose Transgender and gender diverse (TGD) patients face significant hurdles in accessing affirming, knowledgeable care. Lack of provider knowledge presents a substantial barrier to both primary and transition‐related care and may deter patients from seeking health care. Little is known about factors that affect provider knowledge or whether exposure to TGD health content during training is associated with improved knowledge among providers. Using the TGD Healthcare Knowledge Scale, this study aimed to determine whether prior education on TGD health predicts clinicians’ current knowledge regarding health care for TGD patients. Methods An online survey examining exposure to TGD content and knowledge of TGD health care was distributed to all primary care providers in an integrated health care system in the Midwestern United States. Multivariable linear regression was used to predict provider knowledge, controlling for demographics, transphobia and other potential confounders. Results The response rate was 57.3% (n = 223). The mean knowledge score was 7.41 (SD = 1.31) on a 10‐point scale. Almost half (48.4%, n = 108) had no formal education on TGD health care, yet half (49.7%, n = 111) of providers reported previously caring for at least one transgender patient. In regression analysis, provider knowledge of TGD health care was associated with transphobia (β = −0.377, 95% CI = −0.559 to −0.194, p < 0.001), but not with hours of formal education (β = −0.027, 95% CI = −0.077 to 0.023, p = 0.292) or informal education (β = −0.012, 95% CI = −0.033 to 0.009, p = 0.259). Conclusions Increasing hours of education related to TGD health care may not be sufficient to improve providers’ competence in care for TGD individuals. Transphobia may be a barrier to learning that needs to be addressed. Broader efforts to address transphobia in society in general, and in medical education in particular, may be required to improve the quality of medical care for TGD patients.

Debate: Why should gender-affirming health care be included in health science curricula?

“…This highlights the limitations of one-time interventions and call for longitudinal programming to produce more durable improvements. Stroumsa et al [95] caution that transphobia needs to be addressed specifically as a potential barrier to improved knowledge. Their study did not find any association between increased hours of education and improved knowledge, but found a negative association between transphobia and provider knowledge [95].…”

“…Stroumsa et al [95] caution that transphobia needs to be addressed specifically as a potential barrier to improved knowledge. Their study did not find any association between increased hours of education and improved knowledge, but found a negative association between transphobia and provider knowledge [95]. Gamble Blakey and Treharne [96] emphasize values cultivation as a starting point in educating about TGD healthcare, and argue that simply adding curricular content about gender-affirming care may not result in significant learning as this requires a sensitive and specific pedagogic discourse around values [97].…”

Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey

“…Despite this clear need, transgender people face a host of structural barriers to accessing care, ranging from high rates of homelessness attributable to rejection and discrimination, through lack of knowledgeable and affirming clinicians, [15][16][17] to transphobia 18 and direct discrimination in health care settings. 19 In addition, many transgender people in the United States face barriers to insurance coverage for gender-affirming care.…”

Evaluation of a gender-affirming healthcare curriculum for second-year medical students

“…For example, a recent Midwestern study found that transphobia rather than formal education predicts the provider’s knowledge of TGNC healthcare. 24 We agree with Stroumsa and colleagues that medicine, as an institution, may need to reexamine the ‘hidden curriculum’ that helps perpetuate transphobia and trans erasure. 24 Related to the ‘hidden curriculum’, we opted to remove from our curriculum content focused on intersex conditions because faculty had prepared it in a manner inconsistent with gender-affirming cultural competency and terminology.…”