Perceptions And Preparedness: A Study On Lgbt Patient Care Among Medical And Allied Healthcare Students And Practitioners In India Using LGBT-DOCSS

Authors

  • Badri Vishal
  • Deepak Raghav
  • Amit Dwivedi

DOI:

https://doi.org/10.69980/ajpr.v27i2.15

Keywords:

LGBTQ+, Medical Education, Curriculum, Attitudes, Clinical Competence

Abstract

Introduction: LGBTQ+ individuals often have unique healthcare needs, but they also face significant barriers that make it harder for them to access the care and support they deserve.. They continue to face challenges when accessing healthcare, particularly in countries like India, where social stigma and lack of adequate training among healthcare providers contribute to unequal care. [1] There is a lack of comprehensive education on LGBTQ+ healthcare, and students’ understanding of these issues is not well-documented. This study explored the knowledge and attitudes toward LGBTQ+ healthcare among medical, allied health students, and practitioners in India.

Methods: This study used an online self-report survey to collect information on participants' personal and academic backgrounds, as well as their experiences with LGBT-related education during their medical and allied health studies and clinical practice. The total scores from the LGBT-DOCSS, along with the individual scores for the three subscales—clinical preparedness, knowledge, and attitudes—were analysed and compared against international standards.

Results: The sample comprised of 200 respondents, all of the respondents reported a lack of LGBT community-related courses during their studies and clinical practice. The total score on the LGBT-DOCSS was 4.291 ± 0.717 out of 7, indicating a relatively low level of clinical competence. The highest mean score was in the attitude subscale (4.842 ± 1.059), which was significantly higher than the scores for the knowledge subscale (4.323 ± 1.419) and the clinical preparedness subscale (3.722 ± 1.349). Men reported higher levels of knowledge and clinical preparedness, but also showed more negative attitudes compared to women. On comparison with the scores of other countries like Israel, USA and Canada, India was lagging behind significantly in LGBT healthcare training due to Attitude of the people which was significantly lower when compared to other countries leading to such a significant difference in study.

Conclusion: The participants reported low levels of clinical competency, especially in self-reported knowledge and clinical preparedness, but generally had positive attitudes toward the LGBT community. This highlights a crucial need for LGBT-inclusive education in medical and allied healthcare programs in India. The low levels of preparedness among students and clinicians stress the importance of incorporating LGBT-focused training to ensure healthcare providers are better equipped to offer inclusive and culturally competent care. Future studies should assess the long-term impact of such training on patient outcomes and healthcare delivery.

 

Author Biographies

Badri Vishal

PhD Scholar, Department of Orthopedics (Physiotherapy), Santosh Deemed to be University, Ghaziabad

Deepak Raghav

Guide, Professor, Principal, Department of Physiotherapy (Orthopedics), Santosh Medical College, Santosh Deemed to be University Ghaziabad

Amit Dwivedi

Co-Guide, HOD, Dept. of Orthopedics Santosh Hospital, Ghaziabad

References

1. H. C. Karpel, A. Sampson, M. Charifson, L. A. Fein, D. Murphy, M. Sutter, C. L. Tamargo, G. P. Quinn and M. B. Schabath, “Assessing Medical Students’ Attitudes and Knowledge Regarding LGBTQ Health Needs Across the United States,” Journal of Primary Care & Community Health, vol. 14, pp. 1-13, 2023. [2]

2. S. L. Budge, J. L. Adelson and K. A. S. Howard, “Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping.,” Journal of Consulting and Clinical Psychology, vol. III, no. 81, p. 545–557., 2013. [3]

3. L. Arora, P. M. Bhujang and M. Sivakami, “Understanding discrimination against LGBTQIA+ patients in Indian hospitals using a human rights perspective: an exploratory qualitative study,” Sexual and Reproductive Health Matters, vol. 29, no. 2, pp. 1-17, 2022.

4. Indian Penal Code, 2018.

5. R. Klein and M. Elboim‐Gabyzon, “Attitudes of registered physiotherapists in Israel toward people identifying as lesbian, gay, and bisexual: a cross‐sectional survey,” BMC Medical Education, vol. 21, no. 1, p. 581, 2021.

6. S. Peterson, M. Shepherd, J. Farrell and D. I. Rhon, “The Blind Men, the Elephant, and the Continuing Education Course: Why Higher Standards Are Needed in Physical Therapist Professional Development,” Journal of Orthopaedic & Sports Physical Therapy, vol. X, no. 52, pp. 642-646, July 2022.

7. T. Dickson, T. Wilkinson, E. J. Hegedus and A. S. Gisselman, “Transforming the Patient Experience: Moving Beyond Cultural Competence to Cultural Safety,” Physical Therapy, vol. 102, no. 6, June 2022.

8. D. J. Bolding, V. Rodriquez, H. Nguyen and L. A. Drabble, “Survey of Occupational Therapy Students’ Attitudes, Knowledge and Preparedness for Treating LGBT Clients,” Journal of Occupational Therapy Education, vol. 4, no. 2, 2020.

9. Agarwal and A. Thiyam, “Healthcare, culture & curriculum: addressing the need for LGBT+ inclusive medical education in India,” The Lancet RegionalHealth - Southeast Asia, vol. 8, pp. 1-3, 2022.

10. S. Dinkel, B. Patzel, M. J. McGuire, E. Rolfs and K. Purcell, “Measures of homophobia among nursing students and faculty: a Midwestern perspective,” International Journal of Nursing Education Scholarship, 2007.

11. D. B. Kissinger, S. M. Lee, L. Twitty and H. Kisner, “Impact of Family Environment on Future Mental Health Professionals' Attitudes Toward Lesbians and Gay Men,” Journal of Homosexuality, pp. 894-920, 2009.

12. J. A. Sabin, R. G. Riskind and B. A. Nosek, “Health Care Providers' Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men,” American Journal of Public Health, vol. 105, no. 9, pp. 1831-1841, September 2015.

13. K. A. Ensign, A. Yiamouyiannis, K. M. White and B. D. Ridpath, “Athletic Trainers’ Attitudes Toward Lesbian, Gay, and Bisexual National Collegiate Athletic Association Student-Athletes,” Journal of Athletic Training, vol. 46, no. 1, 2011.

14. H. Meyer, “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence,” Psychological Bulletin, vol. 129, no. 5, p. 674–697., September 2003.

15. C. H. B. Ayhan, H. Bilgin, O. T. Uluman, O. Sukut, S. Yilmaz and a. S. Buzlu, “A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings,” International Journal of Health Services, vol. 50, no. 1, pp. 44-61, 2020.

16. T. K. Ahuja, A. D. Goel, M. K. Gupta, N. Joshi, A. Choudhary, S. Suman, K. Taluja, M. Mittal, N. K. Ghuman and N. S. a. P. Bhardwaj, “Health care needs and barriers to care among the transgender population: a study from western Rajasthan,” BMC Health Services Research, vol. 24, 2024.

17. B. A. Caceres, J. Travers, J. E. Primiano, R. E. Luscombe and C. Dorsen, “Provider and LGBT Individuals’ Perspectives on LGBT Issues in Long-Term Care: A Systematic Review,” Gerontologist, vol. 60, no. 3, pp. 169-183, February 2019.

18. Crowe, P. Hogan, C. Morrison, C. Meads and D. Bailey, “Towards inclusive healthcare: evaluating knowledge, confidence and awareness of LGBTQ + health among Internal Medicine Trainees in London,” BMC Medical Education, 2024.

19. M. S. Minturn, E. I. Martinez, T. Le, N. Nokoff, C. E. L. Louis Fitch and R. S. Lee, “Early Intervention for LGBTQ Health: A 10-Hour Curriculum for Preclinical Health Professions Students,” The AAMC Journal of Teaching and Learning Resources, vol. 17, pp. 1-9, 2021.

20. M. P. Bidell, “The Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS): Establishing a New Interdisciplinary Self-Assessment for Health Providers,” JOURNAL OF HOMOSEXUALITY, vol. 64, no. 10, pp. 1432-1460, 2017.

21. D. Z. Nowaskie and A. U. Patel, “How much is needed? Patient exposure and curricular education on medical students’ LGBT cultural competency,” BMC Medical Education, vol. 20, 2020.

22. L. B. Mokkink, C. A. C. Prinsen, L. M. Bouter, H. C. W. d. Vet and C. B. Terwee, “The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument,” Brazilian Journal of Physical Therapy, vol. 20, no. 2, pp. 105-113, 2016.

23. M. Elboim-Gabyzon and R. Klein, “Lesbian, gay, bisexual, and transgender clinical competence of physiotherapy students in Israel,” BMC Medical Education, vol. 24, 2024.

24. D. Z. Nowaskie, A. U. Patel and R. C. Fang, “A multicenter, multidisciplinary evaluation of 1701 healthcare professional students’ LGBT cultural competency: Comparisons between dental, medical, occupational therapy, pharmacy, physical therapy, physician assistant, and social work students,” PLOS ONE, vol. 15, no. 8, 2020.

25. C. A. Primeau, H. T. Philpott, K. Vader, J. Unger, C. Y. Le, T. B. Birmingham and J. C. MacDermid, “Students’ attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs,” BMC Public Health, vol. 23, p. 1661, 2023.

26. L. Zeeman, N. Sherriff, K. Browne, N. McGlynn, M. Mirandola, L. Gios, R. Davis, J. Sanchez-Lambert, S. Aujean, N. Pinto, F. Farinella, V. Donisi, M. Niedz´wiedzka-Stadnik and M. Rosinska, “A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities,” European Journal of Public Health, vol. 29, no. 5, pp. 974-980, october 2018.

27. Burch, “Health Care Providers’ Knowledge, Attitudes, and Self-efficacy for Working With Patients With Spinal Cord Injury Who Have Diverse Sexual Orientations,” Physical Therapy, vol. 88, no. 2, p. 191–198, February 2008.

28. M. H. Ross and J. Setchell, “People who identify as LGBTIQ+ can experience assumptions, discomfort, some discrimination, and a lack of knowledge while attending physiotherapy: a survey,” Journal of Physiotherapy, vol. 65, no. 2, pp. 99-105, April 2019.

29. N. Copti, R. Shahriari, L. Wanek and A. Fitzsimmons, “Lesbian, Gay, Bisexual, and Transgender Inclusion in Physical Therapy: Advocating for Cultural Competency in Physical Therapist Education Across the United States,” Journal of Physical Therapy Education, vol. 4, no. 30, pp. 11-16, 2016.

30. C. A. Primeau, K. Vader, H. T. Philpott and Y. Xiong, “A N eed for Greater Emphasis on 2SLGBTQIA+ Health Among Physiotherapists in Canada,” Physiotherapy Canada, vol. 74, no. 2, pp. 117-120, 2022.

31. R. Pynor, P. Weerakoon and M. K. Jones, “A preliminary investigation of physiotherapy students’ attitudes towards issues of sexuality in clinical practice,” Physiotherapy, vol. 91, no. 1, pp. 42-48, March 2005.

32. D.-J. Janssen and P. Scheepers, “How religiosity shapes rejection of homosexuality across the globe,” JOURNAL OF HOMOSEXUALITY, vol. 66, no. 14, pp. 1974-2001, 2019.

33. H. Watson, D. Harrop, E. Walton, A. Young and H. Soltani, “A systematic review of ethnic minority women’s experiences of perinatal mental health conditions and services in Europe,” PLoS ONE, vol. 14, no. 1, 2019.

34. M. Ross and J. Setchell, “Physiotherapists’ knowledge regarding and experience working with clients who identify as LGBTQIA+,” Journal of Science and Medicine in Sport, pp. 39-40, 2019.

35. Fisher, G. Castellini, J. Ristori, H. Casale, G. Giovanardi, N. Carone, E. Fanni, M. Mosconi, G. Ciocca, E. Jannini, Ricca, Lingiardi and M. Maggi, “Who has the worst attitudes toward sexual minorities? Comparison of transphobia and homophobia levels in gender dysphoric individuals, the general population and health care providers,” Journal of Endocrinological Investigation, 2017.

36. S. Srinivasan, H. Goldhammer, B. M. Charlton, T. McKenney and a. A. S. Keuroghlian, “Addressing Gaps in Access to LGBTQIA + Health Education Resources: A Novel E-Learning Platform,” Journal of Medical Education and Curricular Development, vol. 11, pp. 1-9, 2024.

H. Yu, D. D. Flores, S. Bonett and J. A. Bauermeister, “LGBTQ + cultural competency training for health professionals: a systematic review,” BMC Medical Education, vol. 23, pp. 1-83, 2023.

37. O. Sekoni, N. K. Gale, B. Manga-Atangana, A. Bhadhuri and K. Jolly, “The effects of educational curricula and training on LGBT-specific health issues for healthcare students and professionals: a mixed-method systematic review,” Journal of the International AIDS Society, vol. 20, 2017.

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Published

2024-12-20