1. INSTRUMENT DEVELOPMENT TO ASSESS ATTITUDES AND BEHAVIORS TOWARDS THE LGBT COMMUNITY
AMONG HEALTHCARE AND SOCIAL SERVICES PROVIDERS IN EL PASO, TX, 2014
Objectives
Methods Methods
Acknowledgements
References
Project possible through funding by 2014 UTEP COURI Summer Research
Assistantship. Project development in collaboration with the HIV Community
Mobilization Team LGBT Core partners: City of El Paso Department of Public
Health, Mfactor, OUTright, TTUHSC Office of Diversity Affairs, International
AIDS Empowerment, UTEP Public Health Sciences.
Carlos R. Alvarez BS1, Oralia Loza, PhD1
1 College of Health Sciences, The University of Texas at El Paso (UTEP)
PROJECT
• Development, program, and pilot test of the instrument
ELIGIBILITY CRITERIA
• Pilot Participants (to resemble the target population) :
• Are HCSSP
City of El Paso Department of Public Health Texas Tech University Office of
Diversity Affairs and Children and Youth Gender Clinic, International AIDS
Empowerment, OUTright, Sun City Pride
MEASURES
The instrument will allow data collection for the following measures:
• demographic information:
- Contact Information - Primary Service
- Gender - Years of Practice
- Ethnicity - Specialty
- Age
• Attitudes of HCSSP serving LGBT patients (sample questions):
- How comfortable are you with LGBT patients/clients?
- How comfortable are you employing LGBT friendly staff?
- How comfortable is your staff with LGBT patients/clients?
• Behaviors of HCSSP serving LGBT patients (sample questions):
- Do you ask your patients/clients for their preferred name at their initial visit?
- Has your staff completed LGBT sensitivity training?
- Do you use gender neutral language on intake forms and give choice in
documenting next of kin?
• Willingness to take LGBT sensitivity training and be listed on referral list
INSTRUMENT
• 37-item survey
• Reponses: Likert-Like scale (Strongly Disagree, Disagree, Somewhat Agree,
Agree, Strongly Agree) and Yes/No
• Programmed online on Qualtrics survey software
• Approximately 15 minutes
• piloted to test online and paper versions to test data collection process
• Link sent via email privately to targeted individuals
• One link per participant to avoid viewing other’s responses.
• Will include consent form at the beginning of instrument
Lesbian, Gay, Bisexual, Transgender (LGBT) Community
• In 2011, nine million (3.8%) adults in the United States self-identified as
LGBT (Gates,2011)
• LGBT individuals experience unique health disparities compared to
heterosexual/heteronormative individuals (IOM,2011; Dorsen,2012)
Health Outcomes Affecting the LGBT community
LGBT individuals experience higher rates of:
• HIV/AIDS (Aids.gov,2012)
• HCV among men that have sex with men (MSM) (Division of Viral
Hepatitis,2011)
• Sexually transmitted infections (Lindsey,2003; Mayer, 2008)
• Mental health outcomes (Makadon,2011)
• Substance abuse (Mckay,2011)
Barriers to Healthcare for LGBT Individuals
• Stigma, discrimination and poor understanding of their health needs
(Campbell,2013; Dorsen,2012)
• Negative attitudes from Healthcare and Social Services Providers (HCSSP)
(Dorsen,2012)
• Reluctance to disclose sexual orientation and gender identity information
(Mayer, 2008)
Previous instruments to assess sensitivity to LGBT community
• Kite Homosexuality Scale (Kite, 1986)
• The LGBT Assessment Scale administered to Social Work Students
(Logie,2007)
• The Health Equality Index administered nationally to healthcare providers
(HRC,2011)
El Paso, Texas
• Lack of data on LGBT population and health outcomes
• LGBT organizations in El Paso providing support and services:
• International AIDS Empowement, OUTright, TTUHSC Children and
Adolescent Gender Clinic, El Paso Sun City Pride, Mfactor and PFLAG
Healthy People 2020 LGBT Objective
• “Improve LGBT health , safety and well-being” (USHHS,2014)
• Set of questions that identify LGBT individuals will be included in National
Data Surveys (USHHS,2014)
DATA COLLECTION FOR PILOT TEST
• Participants will be fully informed prior to their participation
• Pilot data collected
• Collect feedback from participants on process (e.g., skip patterns, length of
survey, legibility of the questions, flow, etc.)
• Feedback shared with development team for revisions
• Present revised draft to HIV Community Mobilization Group for feedback
FUTURE STEPS
• Data collection: online through a survey link (Qualtrics) and/or through
paper-copy
• Planned and coordinated with Dr. Oralia Loza of the University of Texas at
El Paso Public Health Sciences Department and with TTUHSC Office of
Diversity affairs. Will involve medical students
• Potential sources for sample population:
El Paso County Medical Society
Texas Tech University Health Science Center
Centro de Salud La Fe
Centro de Salud San Vicente
• Create a referral list including LGBT Friendly HCSSP in El Paso:
- Who agree to be included
- Who arte willing to receive sensitivity training
• Share referral list with partners for LGBT community use
Background and Significance
The objectives of this proposed project are to:
• Explore existing mechanisms used to define and identify LGBT-Friendly
healthcare and social services providers (HCSSP)
• Develop an instrument to assess the attitudes and behaviors of these
providers towards the LGBT community in El Paso, Texas.
• Gates, Gary J. (2011). How many people are Lesbian, Gay, Bisexual, and Transgender? : The Williams Institute, UCLA School of Law.
• Institute of Medicine (IOM). (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, D.C.: The
National Academies Press.
• Dorsen, Caroline. (2012). An integrative review of nurse attitudes towards lesbian, gay, bisexual, and transgender patients. The Canadian journal of nursing research= Revue
canadienne de recherche en sciences infirmieres, 44(3), 18-43.
• Aids.gov. (2012). U.S. Statistics. HIV/AIDS 101. Retrieved April 6, 2014, from http://aids.gov/hiv-aids-basics/hiv-aids-101/statistics/
• Division of Viral Hepatitis. (2011). Viral Hepatitis Surveillance, United States 2011 . National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention.
• Lindley, Lisa L, Nicholson, Thomas J, Kerby, Molly B, & Lu, Ning. (2003). HIV/STI associated risk behaviors among self-identified lesbian, gay, bisexual, and transgender
college students in the United States. AIDS Education and Prevention, 15(5), 413-429.
• Mayer, Kenneth H, Bradford, Judith B, Makadon, Harvey J, Stall, Ron, Goldhammer, Hilary, & Landers, Stewart. (2008). Sexual and gender minority health: what we know
and what needs to be done. American Journal of Public Health, 98(6), 989.
• Makadon, Harvey J. (2011). Ending LGBT invisibility in health care: The first step in ensuring equitable care. Cleveland Clinic journal of medicine, 78(4), 220-224.
• McKay, Becky. (2011). Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources. Medical reference services quarterly, 30(4), 393-401.
• Campbell, Sue. (2013). Sexual health needs and the LGBT community. Nursing Standard, 27(32), 35-38.
• Logie, Carmen, Bridge, Tana J, & Bridge, Patrick D. (2007). Evaluating the phobias, attitudes, and cultural competence of master of social work students toward the LGBT
populations. Journal of Homosexuality, 53(4), 201-221.
• Human Rights Campaign. (2011). Healthcare Equality Index. Retrieved May 25, 2014, from http://www.hrc.org/hei#.U1Q3WfldWoM
• Kite, Mary E, & Deaux, Day. (1986). Attitudes toward homosexuality: Assessment and behavioral consequences. Basic and Applied Social Psychology, 7(2), 137-162.
• United States Department of Health and Human Services, Healthy People 2020. (2014). Lesbian, Gay, Bisexual, Transgender Health. Overview. Retrieved July 9, 2014,
from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25