Designing Implementation Strategies for the Inclusion of Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and Allied and Key Populations' Content in Undergraduate Nursing Curricula in KwaZulu-Natal, South Africa: Protocol for a Multimethods Research Project.

BACKGROUND: Lesbian, gay, bisexual, transgender, intersex, queer, and allied (LGBTQIA+) individuals encounter challenges with access and engagement with health services. Studies have reported that LGBTQIA+ individuals experience stigma, discrimination, and health workers' microaggression when accessing health care. Compelling evidence suggests that the LGBTQIA+ community faces disproportionate rates of HIV infection, mental health disorders, substance abuse, and other noncommunicable diseases. The South African National Strategic Plan for HIV or AIDS, tuberculosis, and sexually transmitted infections, 2023-2028 recognizes the need for providing affirming LGBTQIA+ health care as part of the country's HIV or AIDS response strategy. However, current anecdotal evidence suggests paucity of LGBTQIA+ and key populations' health content in the undergraduate health science curricula in South Africa. Moreover, literature reveals a general lack of health worker training regarding the health needs of LGBTQIA+ persons and other key populations such as sex workers, people who inject drugs, and men who have sex with men. OBJECTIVE: This study aimed to describe the design of a project that aims at facilitating the inclusion of health content related to the LGBTQIA+ community and other key populations in the undergraduate nursing curricula of KwaZulu-Natal, South Africa. METHODS: A multimethods design encompassing collection of primary and secondary data using multiple qualitative designs and quantitative approaches will be used to generate evidence that will inform the co-design, testing, and scale-up of strategies to facilitate the inclusion of LGBTQIA+ and key populations content in the undergraduate nursing curricula in KwaZulu-Natal, South Africa. Data will be collected using a combination of convenience, purposive, and snowball sampling techniques from LGBTQIA+ persons; academic staff; undergraduate nursing students; and other key populations. Primary data will be collected through individual in-depth interviews, focus groups discussions, and surveys guided by semistructured and structured data collection tools. Data collection and analysis will be an iterative process guided by the respective research design to be adopted. The continuous quality improvement process to be adopted during data gathering and analysis will ensure contextual relevance and sustainability of the resultant co-designed strategies that are to be scaled up as part of the overarching objective of this study. RESULTS: The proposed study is designed in response to recent contextual empirical evidence highlighting the multiplicity of health challenges experienced by LGBTQIA+ individuals and key populations in relation to health service delivery and access to health care. The potential findings of the study may be appropriate for contributing to the education of nurses as one of the means to ameliorate these problems. Data collection is anticipated to commence in June 2024. CONCLUSIONS: This research has potential implications for nursing education in South Africa and worldwide as it addresses up-to-date problems in the nursing discipline as it pertains to undergraduate students' preparedness for addressing the unique needs and challenges of the LGBTQIA+ community and other key populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52250.

Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey.

Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.

Providing Inclusive Midwifery Care for 2SLGBTQQIA+ People: Supporting Inclusion in Ontario's Midwifery Education Program.

INTRODUCTION: Research on how midwives in North America are trained to provide inclusive care to Two Spirited, Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, or Asexual (2SLGBTQQIA+) clients is limited. The objective of this study was to define 2SLGBTQQIA+ inclusive midwifery care in the Canadian context and to explore the experiences of graduates of Ontario's Midwifery Education Program (MEP) to determine how midwives are trained to provide inclusive care. METHODS: Ethics approval was obtained for this qualitative study to perform semistructured interviews with graduates from the MEP hosted by McMaster, Toronto Metropolitan, and Laurentian University. Eleven midwives were recruited and were required to be (1) graduates of Ontario's MEP, (2) registered midwives under the College of Midwives of Ontario or elsewhere, (3) currently practicing or on leave, and (4) self-identified advocates for 2SLGBTQQIA+ individuals. RESULTS: When defining 2SLGBTQQIA+ inclusive care, midwives described the following principles: using inclusive language, changing the clinical environment, amending documents and websites, and tailoring care for each client. Participants recognized recent efforts by Ontario's MEP to provide 2SLGBTQQIA+ inclusive education while highlighting the need to expand 2SLGBTQQIA+ content across all courses, practicing inclusive care during placement, and ensuring an inclusive environment in the program. DISCUSSION: Midwives in this study helped conceptualize inclusive midwifery care for 2SLGBTQQIA+ clients and underlined remaining gaps in Ontario's MEP toward providing student midwives with this competency by graduation. This study helped to fill a gap in the literature on how Canadian midwives are trained to provide 2SLGBTQQIA+ inclusive care and generated recommendations for Ontario's MEP to support prelicensure education that trains inclusive midwives. Having demonstrated gaps in how birth workers are trained to provide 2SLGBTQQIA+ inclusive care, this study points to the need for other prelicensure health professional programs to evaluate their training and to support 2SLGBTQQIA+ inclusive practice.

A sexualidade de indivíduos transgêneros: recomendações para profissionais de saúde / The sexuality of individuals transgender: recommendations for healthcare professionals

Indivíduos transgêneros (ou trans) apresentam diferença entre a sua identidade de gênero e o sexo que lhe foi atribuído ao nascimento, o que provoca sofrimento grave, nomeado como disforia de gênero, estado que apresenta melhora após a transição para o gênero autor-reconhecido. Pessoas transgêneras apresentam os piores marcadores de saúde mental entre os LGBTQIA+. O objetivo deste texto é levantar aspectos psicossociais e sexuais de indivíduos transgêneros e trazer algumas recomendações para profissionais de saúde. Os tratamentos disponibilizados para essa população são os de afirmação de gênero (supressão da puberdade, tratamento hormonal cruzado, cirurgia reconstrutiva torácica e cirurgias genitais afirmativas de gênero). Muitas vezes, as alterações corporais conseguem diminuir os sintomas de disforia, melhorando a qualidade de vida. Porém, para muitos deles, apenas a mudança do papel social de gênero é suficiente. As disfunções sexuais mais frequentes experimentadas por mulheres e homens trans são dificuldades para iniciar e buscar contato sexual (mulheres, 26%, homens, 32%) e para atingir o orgasmo (29% e 15%). A atenção à saúde transgênera deve conter cuidados inter e multidisciplinares holísticos, envolvendo endocrinologia, cirurgia, voz e comunicação, atenção primária, saúde reprodutiva, saúde sexual e mental para acompanhar intervenções de afirmação de gênero, bem como prevenção, cuidado e gerenciamento de doenças crônicas. Indivíduos transgêneros enfrentam, além de todas as questões que afligem a sociedade contemporânea, a invisibilidade reforçada principalmente pela falta de conhecimento e pelos preconceitos. Faz-se necessário um atendimento que seja acolhedor, educativo, não preconceituoso e que respeite a individualidade daqueles que carregam em suas histórias sofrimento e violência.

Digital mental health interventions: A narrative review of what is important from the perspective of LGBTQIA+ people.

OBJECTIVES: Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants. METHODS: A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis. RESULTS: Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals-such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems. CONCLUSION: Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation.

Creating change with families: Reflections and recommendations for the care of gender diverse and LGBTQIA+ individuals and their families throughout pregnancy and birth.

OBJECTIVE: To derive a deeper understanding of transgender and non-binary people's experience of pregnancy and birth, and ways to modify practice to provide inclusive care. DESIGN: Case study reports describe the experiences of two transgender and non-binary people who received pregnancy and birth care through a Midwifery Group Practice program. SETTING: A tertiary hospital in metropolitan South Australia with approximately 3800 births per annum. METHODS: Qualitative methodology, utilising open-ended, semi-structured, face-to-face interviews were undertaken postnatally. Interviews were audio recorded and transcribed verbatim to analyse and identify themes. FINDINGS: Both clients feared being misgendered within pregnancy care services. They appreciated the constancy of the Midwifery Group Practice midwife, which meant they did not have to repeat their history to multiple health care providers. They appreciated their pronouns being documented on case notes and welcomed staff attempts to use their preferred terms. Both felt the pregnancy care environment was focussed on cisgender females and found this alienating. They appreciated the midwife's suggestion that the cot card for their baby did not have to be pink or blue. They both suggested staff use more gender-neutral language, and resources, when providing pregnancy care. KEY CONCLUSION: Staff attempted to support these parents, and this was appreciated by them, but the continuity provided by the Midwifery Group Practice model was highly valued by both, regardless of risk status. It was identified that further education for staff was required to facilitate provision of more inclusive care. IMPLICATIONS FOR PRACTICE: The case studies identified a need for greater awareness and education for staff regarding care provision for transgender and non-binary people. Simple adjustments had a big impact. Further research is needed to identify how best to meet the needs of gender-diverse people and address the educational needs of staff.

A educação permanente na atenção integral à saúde do usuário indígena LGBTQIA+: uma experiência inovadora / Continuing education in comprehensive health care of indigenous LGBTQIA+ users: an in-novative experience / La educación continua en atención integral en salud del usuario indígena LGBTQIA+: una expe-riencia innovadora

Este relato de experiência trata sobre o desenvolvimento do Curso de Qualificação em Acolhimento do Usuário Indígena LGBTQIA+, voltado para os profissionais de atenção à saúde indígena do estado da Bahia. Para elaboração do curso, buscou-se conhecer as demandas de saúde dos indígenas LGBTQIA+, porém identificou-se que não há registros oficiais a respeito desse tema e os bancos de dados científicos pouco contribuíram. Em contrapartida, as redes sociais se mostraram uma importante fonte de informações, que possibilitaram a aproximação com os indígenas LGBTQIA+ e suas reais necessidades. A qualificação ocorreu de forma virtual, com duração total de oito horas, por meio da plataforma Zoom. Dos participantes, 91 cumpriram as exigências para a certificação ao final do curso. A partir dos dados de inscrição, foi possível traçar o perfil dos discentes: orientação sexual, identidade de gênero, quesito raça/cor, faixa etária e categorias profissionais. O curso foi avaliado pelos alunos por meio de formulário eletrônico quanto ao conteúdo e à metodologia. Suas respostas foram categorizadas e apresentadas neste relato. A realização dessa qualificação permitiu constatar a existência de uma lacuna no que diz respeito ao preparo de profissionais para atuar no cuidado à saúde integral dos indígenas que se autodeclaram LGBTQIA+, bem como na implementação da Política Nacional de Saúde Integral LGBT. Por fim, essa ação contribuiu para o fortalecimento da parceria entre Secretaria da Saúde do Estado da Bahia (Sesab) e o Distrito Sanitário Especial Indígena do Estado da Bahia (DSEI-BA) na continuidade das ações de educação permanente e, consequentemente, na melhoria da qualidade do cuidado ofertado ao indígena LGBTQIA+.

This experience report concerns the development of a Qualification Course in Indigenous LGBTQIA+ User Care, aimed at professionals in indigenous health care in the state of Bahia. To develop the course, the researchers sought to understand the health demands of Indigenous queer people, but no official records on the topic were found and the scientific databases contributed little. On the other hand, social media proved to be an important source of information, allowing us to approach Indigenous queer individuals and meet their actual needs. Qualification took place virtually, via Zoom platform, with total duration of eight hours. Of the participants, 91 fulfilled the requirements for certification at the end of the course. A student profile was drawn using the following enrollment data: sexual orientation, gender identity, race/color, age group, and professional categories. Students evaluated the course by means of an electronic form, regarding content and methodology. Their responses were categorized and presented in this report. Giving this qualification course allowed us to identify a gap regarding the training of professionals to work in the comprehensive health care of Indigenous LGBTQIA+ people, and the implementation of the National LGBT Comprehensive Health Policy. Finally, this experience contributed to strengthen the partnership between the Department of Health (SESAB) and the Special Indigenous Health District (DSEI-BA) in the State of Bahia in promoting continuing education actions and, consequently, in improving the quality of care offered to Indigenous LGBTQIA+ individuals.

Este relato de experiencia aborda el desarrollo del Curso de Calificación en Acogida de Usuarios Indígenas LGBTQIA+, dirigido a profesionales de la salud indígena en el estado de Bahía (Brasil). Para la elaboración del curso se buscó conocer las demandas de salud de los indígenas LGBTQIA+, pero se identificó que no existen registros oficiales al respecto y que las bases de datos científicas han aportado poco. Por otro lado, las redes sociales demostraron ser una importante fuente de información, lo que permitió acercarnos a los indígenas LGBTQIA+ y sus necesidades reales. La calificación se realizó de forma virtual, con una duración total de ocho horas, mediante la plataforma Zoom. De los participantes, 91 cumplieron con los requisitos para finalizar el curso. A partir de los datos de matrícula, fue posible describir el perfil de los estudiantes: orientación sexual, identidad de género, raza/color, grupo de edad y categorías profesionales. El curso fue evaluado por ellos por medio de un formulario electrónico, en cuanto a contenido y metodología. Sus respuestas se han categorizado y presentado en este informe. La realización de esta calificación nos permitió constatar que existe una brecha en la formación de los profesionales para trabajar en la atención integral en salud de los pueblos indígenas que se declaran LGBTQIA+, así como en la implementación de la Política Nacional de Salud Integral LGBT. Finalmente, esta acción contribuyó al fortalecimiento de la alianza entre la Secretaría de Salud del Estado de Bahía (Sesab) y el Distrito Sanitario Especial Indígena del Estado de Bahía (DSEI-BA) en la continuidad de acciones de educación continua, y la consecuente mejora de la atención ofertada a los indígenas LGBTQIA+.

Lactation Support for LGBTQIA+ Families.

BACKGROUND: Despite a documented underutilization of healthcare by the LGBTQIA+ community due to fear of mistreatment, reproduction incurs a likely dependence on the medical system. Within breastfeeding medicine, the language used for breastfeeding or chestfeeding has broadened and there is an emphasis on inclusion of all types of gender identities; however, that care can be heavily biased toward the inclusion of all breasts/chests in infant feeding. RESEARCH AIM: The purpose of this case study was to examine the impact of queer identity on the gestational and postpartum experience of a bisexual woman married to, and parenting with, a transgender man. It draws into perspective the need to practice in accordance with patients' self-described gender and parenting roles. RESULTS: The parenting roles of this couple were the same as any married, straight, cisgender couple, yet the family identified as queer. The mother in this case experienced low milk production, but the father had had chest reconstructive surgery and started hormones so that they could enter parenthood as the family they had envisioned for themselves. At no point was there any consideration that the father induce milk production for his baby or that chest reconstructive surgery had been mistimed. Their pregnancy support team was supportive of their gender identities and parenting roles, yet they still found themselves orienting and educating the healthcare team throughout their pregnancy and postpartum experience. CONCLUSIONS: Caring for the LGBTQIA+ community requires us to recognize our assumptions and act in affirming ways for all parents, regardless of their family constellation.