Brizzi Lorenzo (Unit of Functional Rehabilitation, Department of Allied Health Professions, Azienda USL Toscana Centro, Italy)
Ferrarello Francesco (Unit of Functional Rehabilitation, Department of Allied Health Professions, Azienda USL Toscana Centro, Italy)
Serafini Isabella (Unit of Functional Rehabilitation, Department of Allied Health Professions, Azienda USL Toscana Centro, Italy)
Transgender individuals (TGDs) are characterized by gender identity (male, female, or other) and biological sex (male, female, or intersex) incongruence. This can cause gender dysphoria, a mood disorder that can lead TGDs to a gender transition. This is an important diagnostic, therapeutic and care pathway that requires multidisciplinary management by healthcare professionals (HCPs), including physiotherapists and speech-language pathologists. Although the importance of education on the management of health needs of TGDs is acknowledged, it is not clear whether existing teaching and learning methods facilitate the development of the necessary level of knowledge and skill. Our aim was to investigate if education programs are effective in changing knowledge, attitudes, prejudice, skills, and level of comfort in clinical practice of HCPs and healthcare students (HCSs) in TGDs care.
Design: overview of systematic reviews. Data sources: MEDLINE, PsycInfo and Embase databases. Last data search, 31 January 2024.
Eligibility criteria: systematic reviews or meta-analyses published in English language since 2018, involving HCPs and HCSs, and focusing on educational interventions aimed at facilitating access to care and reducing health inequalities in the TGD population. We extracted data on the characteristics of the studies included. Specifically, we investigated study design, sample size, target population, participants’ professional profile, interventions’ features
(e.g., educational strategies, delivery modality, setting, duration), and outcome measures. We systematically assessed the methodological quality of the included studies with the AMSTAR-2 tool. We synthesized the findings through qualitative analysis.
Four systematic reviews were retrieved, including 13, 21, 26, and 29studies, respectively.1-4 One systematic review focused on LGBTQ-related prejudices, two of them were about LGTQ+ health in HCSs’ education, and one highlighted outcomes of gender-sensitivity education in HCPs. Overall, the reviews focused on the implementation of educational interventions to improve knowledge, skills and comfort level in clinical practice, and to reduce prejudices. Interventions were based on didactic lectures, role-playing, multimodal pedagogy with and without simulation, and others. Multimodal and practice-oriented trainings were the most implemented. The studies included in the reviews showed a wide heterogeneity in study design; interventions researched, and reported outcome variables. The outcome measures were often non-validated. According to the AMSTAR-2 tool the reviews had critically low levels of confidence.
The included reviews suggest that educating health professionals and students about TGDs’ health is appropriate, but there is not clear evidence on the most effective intervention. There is a lack of well-designed primary studies on teaching strategies, their combination and delivery methods, aimed at reducing healthcare inequalities and discrimination against TGDs. The results of our overview also suggest the need to establish general agreement on validated outcome measures in order to compare the effectiveness of educational programs. In future developments, the agreement on outcome measures may allow a better comprehension of the effectiveness of interventions. It will increase the understanding of the impact of strategies and their combinations on the behaviour of HCPs and HCSs and, consequently, on the healthcare-related experiences of the TGDs. Our study can be a stimulus for the promotion of education on the management of TGDs’ health needs.
