Cultural Competence in Healthcare as it Relates to the LGBT Community
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Recent research suggests a link between the overall satisfaction of healthcare experiences with medical providers and their staff with LGBTQ+ cultural competence. Cultural diversity training is an integral part of the learning curriculum for our future healthcare providers and their staff. Individuals that identify with the LGBTQ+ community have higher diagnosis rates for several life-threatening illnesses and diseases such as mental health issues, certain cancers, and HIV/AIDS. In order to improve health equity and degree of satisfaction with healthcare in the LGBTQ+ community, the level of cultural competence among healthcare providers and their staff needs to improve. This can be achieved by providing cultural sensitivity training focused on the LGBTQ+ community.
Medical schools in North America do not have the adequate curriculum to train future providers about the special needs of people in the LGBTQ+ community. Across 132 medical schools in North America, the average length of LGBTQ+ specific related curricula is 5 hours (Dudar et al. 48). Out of these 132 medical schools surveyed, 9 schools reported there was not materials or teachings dedicated to the LGBTQ+ community (Dudar et al. 48). If training is not provided to future medical professionals early on in their studies, they do not have time to develop these skills before they enter a professional environment.
Cultural diversity training specific to the LGBTQ+ community is an integral part of the learning curriculum for our future healthcare providers. Studies show curriculum dedicated to increasing the knowledge and awareness of medical issues experienced by individuals that identify with the LGBTQ+ community is successful among future healthcare providers (Dudar et al. 48). A study was conducted to demonstrate the effectiveness of diversity training. The study was 12 weeks long and issued to medical students as part if their curriculum. This 12 week training designed to reduce implicit bias, shows signs of success as early as week 2. Individuals reported an improvement being able to recognize bias within themselves and how it could contribute to discrimination in the community (Devine et al. 1273).
Individuals in the LGBTQ+ community are more likely to have mental health issues than heterosexuals. Having a greater chance of being plagued with mental illness makes it vital that proper healthcare and treatment is obtained. Until the 1970's, Homosexuality was defined by the American Psychiatric Association as a "sociopathic personality disturbance" (Russel and Fish 3). According to a 2016 study, more than 20% of LGBTQ+ adults attempted suicide at some point in their life (Hottes et al. 1). Only 4% of heterosexual adults reported a suicide attempt during their life (Hottes et al. 1). A survey conducted reported 50% of people that identify as LGBTQ+ have had suicidal ideations in the last year (Hottes et al. 1). These astounding statistics, call for serious interventions in the medical community when it comes to diagnosing and treating mental illness in the LGBTQ+ community.
A study was conducted to determine if people within the LGBTQ+ community felt discrimination while seeking healthcare services. During this 2016 study, it was reported that more the 33% of the 1,500 people surveyed that identify with the LGBTQ+ community stated they experienced discrimination in the last 365 days (Olsen). Out of the individuals that reported discrimination by a healthcare provider or their staff, 15% of the individuals surveyed stated they had a fear of repeated ill treatment and discrimination that caused them to delay seeking medical care (Olsen). Every human being regardless of gender or sexual orientation have the right to healthcare without the fear of discrimination. No person should delay seeking treatment or preventative care because they fear poor treatment.
Individuals in the LGBTQ+ community have higher diagnosis rates for certain treatable cancers. Gay men have a reported 50% higher odds of a cancer diagnosis than heterosexual men (Olsen). Gay and bisexual females have a 70% higher chance of reporting a cancer diagnosis than heterosexual females (Olsen). These higher rates are attributed to not receiving proper preventative care and early detection screenings. A cancer treatment medical group issued a survey to a group of their oncologists to determine the knowledge and level of comfort among providers when it came to patients that identify with the LGBTQ+ community. Out of 388 oncologists surveyed at this institution, 91.7% acknowledged being comfortable treating people identifying with the LGBTQ+ community (Tamargo et al. 93). This group of 91.7% of oncology practitioners would support the further development of LGBTQ+ education and training plans related to their unique needs when it comes to cancer treatment (Tamargo et al. 93). A group of questions on this survey issued to physicians within this oncology treatment center were focused on specific care and needs of the LGBTQ+ community. Unfortunately, out of the 388 oncologists surveyed, only 49.5% were able to answer questions correctly that are related to the specific health needs of LGBTQ+ individuals (Tamargo et al. 93).
Another serious and potentially deadly medical problem among the LGBTQ+ community is the HIV and AIDS virus. HIV diagnosis rates are dramatically higher in the LGBTQ+ community than heterosexual individuals. A study conducted by the CDC in 2019, reported that there were 25,552 gay and bisexual males diagnosed with HIV ("HIV"). This population of males that identify as gay represents 69% of all new HIV diagnoses reported in 2019 (HIV). In 2019, 2% of all new HIV diagnoses are people that are transgender (HIV). Gay and bisexual males having fear of judgment and poor attitudes can discourage people in this community from getting HIV testing, treatment and preventative care (HIVinfo). Fear of discrimination and judgement are some of the factors directly related to the dramatically higher percentage of HIV diagnoses among the LGBTQ+ community verses people that are heterosexual.
Transgender individuals have higher satisfaction with medical providers that are knowledgeable about specific heath issues that transgender people deal with. A survey released was issued to willing participants in the transgender community to determine disparities faced within several aspects of life. The data that we will focus on is related to healthcare and medical treatment. Out of the transgender participants surveyed, 33% reported they had poor experiences with healthcare providers because they were transgender (US Transgender Survey). This survey conducted in 2015, reports 23% of transgender individuals refused to seek medical treatment in the last 12 months because they were afraid of being treated terrible simply because they are transgender (US Transgender Survey). This is another study that demonstrates there is negative attitudes towards the LGBTQ+ community that impacts their ability to seek and receive proper medical care. Another surprising result of this survey conducted in 2015, shows that 33.5% of transgender individuals, do not have a provider for trans-related care (Katchen and Pharr 145). This is more than one third of all transgender people in the United States not having someone to provide them with care dedicated to their specific needs. The survey participants in this 2015 study reported only 2.8% of individuals that have a primary care provider or routine care provider that "knows almost everything" about trans-related care (Katchen and Pharr 145). That is less than 3 transgender people out of every 100 transgender people that can attest they have a provider that is very knowledgeable about unique experiences and health needs. An equally shocking result shows that 19.4% of the individuals surveyed reported their primary care provider "knows almost nothing" about trans-related care (Katchen and Pharr 145).
A study was performed to determine the effectiveness of cultural competence and sensitivity training focused on the LGBTQ+ community. To determine the effectiveness of this training an assessment was given to clinic staff before the started the training as well as after the conclusion of the training. Prior to formalized training, the average score on the LGBTQ+ cultural competencies assessment was 52.5% (Felstein 145). After the completion of the cultural sensitivity training, the average score increased to 80.2% on the cultural competencies of the LGBTQ+ community (Felstein 145). A survey was also given to all staff members after they completed their training dedicated to LGBTQ+ sensitivity training to gain feedback and effectiveness of the training. More than 72% of these employees felt they were better prepared the address the specific needs and care of those that identify with the LQBTQ+ community (Felstein 145). This study proved that training can not only improve the level of care between medical staff and patients that identify with the LGBTQ+ community but it also helped staff to feel better equipped to foster positive interactions with their patients in this community.
There are many simple techniques and methods to improving cultural competence involving people within the LGBTQ+ community. Healthcare providers that receive training during medical school will be able to be better prepared for treating and serving patients in the LGBTQ+ community. Specific training focused on cultural competence and sensitivity to the LGBTQ+ community is not only essential for medical provider, but it is vital for their staff to receive training as well. Clinic and office staff members are usually the patient's first point of contact with the medical provider. Training on specific terminology and concepts used in the LGBTQ+ community can help to improve cultural competence (Bass and Nagy 2). This will allow medical providers and their office staff to be able to better relate to patients within the LGBTQ+ community. Another example to improve cultural competence among the LGBTQ+ community is medical providers and their staff can learn health risks that are specific and unique to the LGBTQ+ Community (Bass and Nagy 8). These trainings can be done during initial onboarding and training of new staff. This is also training that can be done periodically not only to act as fresher training, but to also provide updates and new techniques. By taking action to improve cultural competence among providers and their staff can increase overall patient satisfaction, improve mental health, provide earlier detection for treatable cancers and reduce the spread of HIV and AIDS among the LGBTQ+ community.
Works Cited
Bass, Brittany, and Hassan Nagy. "Cultural Competence in the Care of LGBTQ Patients." StatPearls, 9 Oct. 2021, pp. 1-9, US National Library of Medicine
Devine, Patricia G et al. "Long-term reduction in implicit race bias: A prejudice habit-breaking intervention." Journal of experimental social psychology
Dudar, K., et al. "Queering the Medical Curriculum: How to Design, Develop, Deliver and Assess Learning Outcomes Relevant to LGBT Health for Health Care Professionals." MedEdPublish
Felsenstein, Denise R. "Enhancing Lesbian, Gay, Bisexual, and Transgender Cultural Competence in a Midwestern Primary Care Clinic Setting." Journal for nurses in professional development
HIV. United States Department of Health and Human Services
HIVinfo. National Institute of Health
"HIV and Gay and Bisexual Men: HIV Diagnoses." Center for Disease Control and Prevention
Hottes, Travis, et al. " Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis." American Journal of Public Health, vol 106, 5, May 2016, 1-12. American Public Health Associates
Katchen, Axenya, and Jennifer R Pharr. "Health Care Access and Utilization by Transgender Populations: A United States Transgender Survey Study." Transgender Health, vol. 5, 3, 2 Sep. 2020, pp. 141-48. Mary Ann Liebert, In. Publishers
Olsen, Karen. "AACR Conference Examines Cancer Disparities in the LGBTQ Population." American Association for Cancer Research
Quinn, Gwendolyn P et al. "Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations." CA: a cancer journal for clinicians
Russell, Stephen T, and Jessica N Fish. "Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth." Annual Review of Clinical Psychology, vol. 12 (2016): 465-87. National Center for Biotechnology Information
Tamargo, Christina L et al. "Cancer and the LGBTQ Population: Quantitative and Qualitative Results from an Oncology Providers' Survey on Knowledge, Attitudes, and Practice Behaviors." Journal of Clinical Medicine vol. 6,10, 7 Oct. 2017, 93. National Center for Biotechnology Information
US Transgender Survey. National Center for Transgender Equality
