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This article describes capacity building and formative assessments completed at five faith-based organizations (FBOs) in Washington, DC to inform sustainable health promotion programming led by certified health ministers. Five FBO partners were recruited with two congregation members from each FBO completing a health minister certificate program. A series of health assessments were conducted to assess each FBO's capacity to implement evidence-based lifestyle change programs that are responsive to congregation members' health needs. Results indicated a need for programming to support older adults in managing high blood pressure and arthritis. Health ministers represent a significant opportunity for building capacity within FBOs to deliver programming that can improve health outcomes.
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Transgender and gender nonconforming (TGNC) patients have been seeking medical care in higher numbers and have faced unique social, personal, and health issues that affect the quality of care they receive. The purpose of this study was to conduct a mixed-methods study to describe TGNC care at Kaiser Permanente Mid-Atlantic States, a large integrated health system. We used a transgender registry to describe a TGNC patient population and compared healthcare utilization between TGNC patients and non-TGNC patients. Four focus groups were also conducted among 28 patients. Atlas.ti software was used to code and analyze themes for the qualitative analysis. Among the 282 adults TGNC patients, the mean age was 32.6 years. Of the study sample, 59% were White, and 27% were Black. TGNC patients demonstrated an increased use of email/telephone visits and the online patient portal and more cancellations and no-shows compared to non-TGNC controls. Of the 28 TGNC patients who participated in the focus groups, 39% identified as female, 21% as a transman, and 18% as non-binary/genderqueer. Participants were predominantly White (68%), highly educated (74%), and reported use of hormones (89%). Themes that emerged from our qualitative analysis included: limited availability of TGNC information; positive and negative sentiments regarding patient-provider interactions; issues with case management; limited access to care; lack of coordination of care; negative staff experiences. We identified specific areas in a health system to improve the quality of care of TGNC patients, including specific TGNC training for providers and staff, a source of TGNC information/resources, and hiring and training TGNC-specific case managers.
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BACKGROUND: Transgender and gender-nonconforming (TGNC) patients have inadequate quality of care. Few studies have examined the issues related to quality of care from the perspective of providers. The purpose of this pilot study was to understand the barriers and facilitators of quality TGNC care and develop recommendations for health systems. METHODS: We used phenomenological methods in the form of qualitative semistructured interviews to allow provider participants to elaborate about issues not covered in the script questions. Audio files from 11 provider interviews were transcribed and summarized by common themes. Thematic analysis was conducted in an iterative process to extract insights from the data. RESULTS: Six main subthemes resulted from our qualitative review regarding "barriers to quality care": 1) provider training and knowledge of TGNC care, 2) provider and staff interactions with TGNC patients, 3) case management, 4) misgendering, 5) access and continuity of care, and 6) bias and discrimination. Four subthemes were identified as "facilitators of quality care" for TGNC patients: 1) skilled staff, 2) continuity of care and electronic health records, 3) organizational support, and 4) provider-patient interactions. Additional needs were also suggested. CONCLUSIONS: Findings were distilled into 3 recommendations to improve the quality of TGNC care: 1) establish a dedicated case-management team; 2) provide access to more in-depth and meaningful training for providers, clinic staff, and administrative staff (and mandate certain basic training); and 3) allocate financial resources and enforce a policy of nondiscrimination.