It is important to note that health inequality and disparity is a significant problem that requires systematic solutions. Although the existing literature is substantive in providing evidence for the presence of the issue, there are no significant proposed measures to address a health disparity observed within a transgender community. The problem statement is centered around the healthcare inequality experienced by members of the transgender community, where the common barriers include socioeconomic barriers, financial factors, lack of cultural competence of healthcare providers, and discrimination within the healthcare system. The key purpose of the study is to systematically assess and study the health disparity factors affecting the vulnerable target population. A systematic set of recommendations and solutions will be proposed as well in order to address the problem comprehensively.
Literature Review
Research Question, Hypothesis, and Variables with Operational Definitions
The underlying PICOT research question is as follows: In the transgender population (P), how does applying the Nola Pender’s Health Promotion Model (I) compared to the cisgender community (C) improve the barriers, such as socioeconomic barriers, financial factors, lack of cultural competence of healthcare providers, and discrimination within health care system (O), over a six-month period (T)? The hypothesis is rooted in the notion of the identified barriers, which necessitate the use of systematic solutions, which encompass cultural competence increase among healthcare workers to policy-based interventions to address discrimination and poverty. The core variables include the cultural competence of nurses and doctors, financial metrics of transgender people, discrimination rate experienced by the target population, and socioeconomic status measurements. The former variable refers to a healthcare professional’s ability to communicate in a cross-cultural setting successfully. Financial metrics the average income among transgender people, whereas socioeconomic status is a level of poverty, insurance coverage, education, and employment. Discrimination is prejudicial or unfair treatment of members of the transgender community.
Summary of the Evidence for the Proposed Study
On the basis of the literature reviewed, which will be discussed in detail in the section below, it can be stated that the problem exists and persists. Firstly, transgender people are more reluctant to seek help from healthcare professionals due to expected discrimination and incompetence. Secondly, healthcare providers have little to no knowledge of treating transgender individuals. Thirdly, there is a problem of systematic discrimination against the LGBTQIA2S+ community, including transgender members. Fourthly, the target population is financially vulnerable due to higher rates of poverty and low socioeconomic status.
Detailed Literature Review
In order to thoroughly and systematically assess the problem statement, it is important to define the target population beforehand. Transgender people “are those whose gender identity does not align with the gender assigned at birth. Gender and sexuality are two different phenomena that may or may not be congruent with gender identity” (National Organization of Nurse Practitioner Faculty, 2019, p. 502). A study found that healthcare professionals reported insufficient competence levels in working with transgender patients, which is compounded by the fact that there is a “lack of access to care for transgender people” (Burgwal et al., 2021, p. 1). Another research states that “the lack of education in transgender care continues among providers across all levels of medical education from medical students and physician trainees to primary care providers, endocrinologists, and other specialists” (Korpaisarn & Safer, 2018, p. 271). In other words, there is a strong piece of evidence directing toward the need to both raise awareness and improve the competence of healthcare professionals in working with the target population.
When it comes to healthcare access limitations experienced by transgender people, the literature provides substantive findings to support their existence and identification. There is a number of core barriers for the LGBTQIA2S+ community, including transgender members. These include “lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers” (Safer et al., 2016, p. 168). Thus, it is evident that the selected variable for the proposed study is substantiated with evidence and literature support.
In the case of discrimination, the issue not only worsens or hinders the healthcare service quality provided but additionally makes the target population self-destructive. It was found that transgender “individuals were more likely to report postponement of health care utilization due to fear of discrimination and had experienced discrimination in the health care setting than NB respondents” (Kachen & Pharr, 2020, p. 141). In other words, discrimination makes transgender people more reluctant to seek help in a timely manner. The problem translates and extends to pelvic examinations, vaccinations, and other important healthcare services irrespective of the insurance status (Stewart et al., 2020). Lastly, the overall socioeconomic status factors and wellness elements were low compared to cisgender populations (Gagnon et al., 2022). Thus, transgender people regularly face and fear discrimination, experience lower access to healthcare with insufficiently competent healthcare professionals, and tend to have less financial means.
Theoretical Framework
The selected theoretical framework is Nola Pender’s Health Promotion Model, which uses the whole person and the aspects of health. Its guiding proposition is that health is a “positive dynamic state, not merely the absence of disease” (Gonzalo, 2021, para. 21). It should be noted that “the model focuses on the following three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes” (Gonzalo, 2021, para. 22). The application will be based on assessing patients systematically for their perceived self-efficacy, perceived barriers, perceived benefits, interpersonal influences, and situational influences that are relevant to the health behavior (Peterson & Bredow, 2016). The selected framework identifies several characteristics of the client, which include behavior, demographic, and health status (Peterson & Bredow, 2016). Pender’s theory is based on the nursing process to produce behavior change, and Health Promotion is based on the theory of human behavior (Peterson & Bredow, 2016). The research study to improve health disparities among transgender people to promote health, prevent illnesses, and achieve a higher level of self-actualization and well-being.
The two human behavior theories that are the makeup of the Health Promotion model are expectancy-value theory and social cognitive theory. According to the expectancy-value theory, “people are more likely to work toward goals that are of value to them” (Peterson & Bredow, 2016, p. 64). The social cognitive theory proposes that the greater a person’s self-efficacy for behavior, the more likely the person will engage even when obstacles are present (Peterson & Bredow, 2016). The project’s focus is to identify the barriers and assess the transgender population to create a change agent to increase access to care, prevent illnesses, and promote health.
Methodology
Sample and Sampling Strategy
The sample for the research study is the transgender community, and the inclusion criteria are centered around transgender individuals who do not have access to care. The sampling environment will be conducted in the primary care office or urgent care. The sampling strategy will include 25-30 people from the transgender community, male and female individuals with a median age of 26-year-old (18-35 yrs. old). The sample is selected from a diverse group of transgender people who have experienced a lack of access to care. Some individuals have a history of HIV, substance abuse, no health conditions or pre-disposing conditions, individuals that have begun hormone therapy, and mental health issues. The diverse population allows research study to reflect the challenges the identified population faces when trying to obtain care. The technique used to ensure all participants have the chance to take part in the study will implement a random sampling. The population will receive consent prior to the study if chosen for the research. The research will include providers and cisgender individuals.
Research Design and Extraneous Variables
The research study design will be a quantitative random controlled trial to determine the improvement of health disparities in the targeted population. The decrease in the barriers that contribute to transgender individuals not being able to receive the care needed. The research design will allow the research question and answers to the study to prove health disparities in the transgender community. Extraneous variables include small sample size and inclusion criteria bias, which will be addressed through randomization and increase of the sample size on the basis of the availability of the participants.
Description of Intervention
The intervention will be based on Nola Pender’s Health Promotion Model with an emphasis on expectancy-value theory and social cognitive theory. The systematic study of transgender people will be conducted in order to identify the implications of the theoretical framework when applied to the target population. Improvement measures will be implemented in a healthcare organization to address the key barriers through the health promotion system to increase the cultural competency of healthcare professionals, enable greater access, and provide essential support. The elimination of discrimination, cultural incompetency, and access factors is expected to result in increased health outcomes and patient satisfaction reported by the participants.
Instruments, Data Collection, and Data Analysis
The key instrument will be a questionnaire and survey conducted at the beginning and the end of the intervention, accompanied by an in-depth study of the core metrics. The demographic variables will be examined through descriptive statistical tests to determine relevant patterns and limitations in terms of vulnerable populations. The individuals will be selected by random sampling of each population, and the measures will be socio-demographic variables, such as age, gender at birth, and identified gender. Data analysis for study variables will be conducted and illustrated through a t-test from the parametric class of inferential statistics.
The Likert scale is used to measure the dependent variable, which results in interval level measurement of the study. The t-test will be conducted to determine the true difference in the two groups by implementing the formula, which involves computing the denominator in the formula, which is the standard error of the difference between the means. The interventions will be implemented after the GCLS scale, data, discussions, and questionnaires have been completed. These measures will consist of actions to take to eliminate the barriers of discrimination, lack of cultural competence by providers, and health system barriers.
The variables will be reassessed, and the GCLS scale will be completed after 30 days of implementing the interventions to eliminate barriers for the transgender population. Then after completing the reassessment, the hypothesis of the research will be retested, and data will be collected to answer the problem statement/PICOT question. The proposed methodology will generate reliable data and a clear overview of health disparities and their effect on access to healthcare. Moreover, as both objective and subjective data will be gathered, the findings will portray an in-depth overview of perceived and physical limitations affecting the transgender community in regard to healthcare services.
Ethical Issues
The key ethical consideration revolves around communication of results, the potential for harm, anonymity, informed consent, and voluntary participation. The participants will be fully informed about the purpose, methods, and aims of the study. They will be granted full anonymity and confidentiality within the possible means. The proposed research is aware of the harms of discrimination, which is why the necessary protective measures will be put in place. All findings and results will be available for the participants. Consent will be obtained after the participants are fully informed of the study’s approach and contents in a written form, as shown in the Consent Form of the Appendix. The underlying limitation of the study is the presence of confounding variables from socioeconomic and financial domains, which cannot be controlled for due to their policy-based and social nature. However, it has massive implications for practice since many of the barriers can be addressed through training and change of cultural competencies among healthcare providers.
References
Burgwal, A., Gvianishvili, N., Hård, V., Kata, J., & Isidro, G. N. (2021). The impact of training in transgender care on healthcare providers competence and confidence: A cross-sectional survey. Healthcare, 9(8), 1-15. Web.
Gagnon, K. W., Bifulco, L., Robinson, S., Furness, B., Lentine, D., & Anderson, D. (2022). Qualitative inquiry into barriers and facilitators to transforming primary care for lesbian, gay, bisexual and transgender people in us federally qualified health centers. BMJ Open, 12(2), 1-10. Web.
Gonzalo, A. (2021). Nola Pender: Health promotion model. Nurselabs. Web.
Kachen, A., & Pharr, J. R. (2020). Health care access and utilization by transgender populations: A united states transgender survey study. Transgender Health, 5(3), 141–148. Web.
Korpaisarn, S., & Safer, J. D. (2018). Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons. Reviews in Endocrine and Metabolic Disorders, 19(3), 271–275. Web.
National Organization of Nurse Practitioner Faculty. (2019). A toolkit on patient centered transgender care for nurse practitioner faculty and clinicians. The Journal for Nurse Practitioners, 15(7), 502-505. Web.
Peterson, S. J., & Bredow, T. S. (2016). Middle range theories: Application to nursing research and practice (4th ed.). LWW.
Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to health care for transgender individuals. Current Opinion in Endocrinology, Diabetes & Obesity, 23(2), 168–171. Web.
Stewart, T., Lee, Y., & Damiano, E. A. (2020). Do transgender and gender diverse individuals receive adequate gynecologic care? An analysis of a rural academic center. Transgender Health, 5(1), 50–58. Web.
Appendix
Consent Form
Name “Health Disparities in the Transgender Population”
- I confirm that I have read and understood the information provided about the project in the Information Sheet for Participants. Date:
- I confirm that I had the opportunity to request additional information about the research’s risks, benefits, and personal health data from the researcher.
- I confirm that all my questions were answered extensively and in-depth with no confusion and misunderstanding, and the responses and clarifications were satisfactory.
- I fully understand that my participation is voluntary and not forced. I am free to withdraw from the project at any moment and time without providing any reasons.
- I understand that I can withdraw my personal health data from the project at any time and moment.
- I am fully aware of the risks and benefits of the research.
Participant’s signature ______________________________ Date __________
Investigator’s signature _____________________________ Date __________
Participant’s Initials: