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Structural competency in emergency medicine services for transgender and gender non-conforming patients

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  • Willging, Cathleen
  • Gunderson, Lara
  • Shattuck, Daniel
  • Sturm, Robert
  • Lawyer, Adrien
  • Crandall, Cameron

Abstract

In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6), nurses (n = 7), and non-clinical staff (n = 7) in four community-based EDs in New Mexico. Our iterative coding and analysis process resulted in eight sets of findings: (1) reasons why TGGNC patients seek care from EDs; (2) perceptions about and experiences of TGGNC patients; (3) relevance of gender identity and sex at birth; (4) bureaucracy and communication; (5) spatial considerations; (6) preparing providers and staff to care for TGGNC patients; (7) the lack of resources for structural prescriptions; and (8) respect, humanity, and sameness. Findings suggest that structural issues adversely impact the health and wellbeing of TGGNC patients and service-delivery practices in the ED. We describe study implications for training ED personnel and modifying this practice setting to prevent delayed care and ensure appropriate services for TGGNC patients in need of structurally competent emergency medicine.

Suggested Citation

  • Willging, Cathleen & Gunderson, Lara & Shattuck, Daniel & Sturm, Robert & Lawyer, Adrien & Crandall, Cameron, 2019. "Structural competency in emergency medicine services for transgender and gender non-conforming patients," Social Science & Medicine, Elsevier, vol. 222(C), pages 67-75.
    • Handle: RePEc:eee:socmed:v:222:y:2019:i:c:p:67-75
    DOI: 10.1016/j.socscimed.2018.12.031
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    References listed on IDEAS

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    1. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
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    4. Metzl, Jonathan M. & Petty, JuLeigh & Olowojoba, Oluwatunmise V., 2018. "Using a structural competency framework to teach structural racism in pre-health education," Social Science & Medicine, Elsevier, vol. 199(C), pages 189-201.
    5. White Hughto, Jaclyn M. & Reisner, Sari L. & Pachankis, John E., 2015. "Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions," Social Science & Medicine, Elsevier, vol. 147(C), pages 222-231.
    6. Cruz, Taylor M., 2014. "Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination," Social Science & Medicine, Elsevier, vol. 110(C), pages 65-73.
    7. Hatzenbuehler, Mark L. & Bellatorre, Anna & Lee, Yeonjin & Finch, Brian K. & Muennig, Peter & Fiscella, Kevin, 2014. "Structural stigma and all-cause mortality in sexual minority populations," Social Science & Medicine, Elsevier, vol. 103(C), pages 33-41.
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    2. Kynn, Jax & Boyke, Hannah & McCarthy, Sam & Gzesh, Ari S., 2024. "Structural vulnerabilities and over-criminalization of LGBTQ + youth in the California justice system," Children and Youth Services Review, Elsevier, vol. 160(C).

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