Online Program

317860
Transgender and Gender NonConforming in the Emergency Department: Power Inequity, Stigma and Self-Efficacy


Monday, November 2, 2015

Makini Chisolm-Straker, MD, MPH, Department of Emergency Medicine, The Icahn School of Medicine at Mount Sinai, Mount Sinai Brooklyn, New York, NY
Logan Jardine, MD, MPH, Emergency Medicine, SUNY Downstate Kings County Hospital, NYC, NY
Cyril Bennouna, MPH, Population and Family Health, Mailman School of Public Health at Columbia University, NYC, NY
Nina Morency-Brassard, MPH, Population and Family Health, Mailman School of Public Health at Columbia University, NYC, NY
Lauren Coy, MPH, Population and Family Health, Mailman School of Public Health at Columbia University, NYC, NY
Maria Olivia Egemba, MS, MPH, Population and Family Health, Mailman School of Public Health at Columbia University, NYC, NY
Peter Shearer, MD, Emergency Medicine, Mount Sinai Medical Center, NYC, NY
Background: A few studies have quantitatively found that individuals with a transgender or gender nonconforming (TGGNC) experience avoid Emergency Departments (EDs) and/or have negative experiences. This study qualitatively examines TGGNC persons’ reasons for use or non-use of the ED, experiences in US EDs and recommendations for improving the emergency care of this population.

Methods: This retrospective, anonymous, written (paper and online), national study started in June 2012 and closed December 2014. 236 responses were analysed using a conceptual framework based on well accepted health behavioural theories. A team of six investigators developed a codebook that emerged from the participants’ responses and was applied to responses using NVivo 10. A data display was created to organize coded data into positive or negative categories and examined for emerging overarching themes.

Results: Using the above methods, the themes of Respect, Self-Efficacy and Power Inequity surfaced. These themes exposed the tension between self-identified TGGNC patients and providers who lack training in nonbinary gender identities or histories. When providers had specific training about this population, participants reported positive care experiences.

Conclusions: The traditional provider-patient power dynamic and trust is disrupted by the exposure of gaps in provider education and training around TGGNC care. Data from this study indicates that systematic training of ED providers, on how to interact with and the specific health issues of this diverse group, is necessary to improve the care of this marginalized population.

Learning Areas:

Advocacy for health and health education
Diversity and culture
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
Define the terms "transgender" and "gender nonconforming." Explain how lack of provider awareness and expected gender binary contribute to negative experiences for TGGNC patients in US EDs. List three recommendations, of TGGNC persons, for ED providers to improve the care of TGGNC patients.

Keyword(s): Gender, Emergency Medical Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: study conception, development, implementation, data analysis, manuscript drafting
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3308.0: Relevant LGBT Topics 2