Abstract
People who identify as sexually or gender diverse often fail to find care that is inclusive and unbiased. Cultural humility provides a framework as an approach to care that includes the principles of lifelong learning, self-reflection, the recognition and challenge of power imbalances, and institutional accountability. This approach provides a valuable heuristic for clinicians interested in combatting biases and promoting inclusivity. Cultural humility was first described as an approach to care in 1998 when health care providers in the United States were searching for a way to better meet the needs of a culturally, ethnically, and racially diverse population. The approach can be applied by providers, researchers, advocates, and others when working with individuals or populations different from one’s own in any cultural context such as gender, sexual orientation, religion, or ethnicity. Within the framework of cultural humility, knowledge is viewed as something to be obtained over a lifetime as opposed to reaching an endpoint of a sufficient level of understanding. The practice of self-reflection is a component of lifelong learning and is used to evaluate and inform future care. Institutions play a role in ensuring that the care provided to sexually and gender diverse people is unbiased and inclusive. Institutions can live out their stated value of nondiscrimination by embracing a power structure that is inclusive, opposing public policies that marginalize sexually and gender diverse people, and providing a community presence that is diverse and welcoming.
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References
American Civil Liberties the Country. (2021). Retrieved May 31, 2021. https://www.aclu.org/legislation-affecting-lgbt-rights-across-country
American College of Obstetricians and Gynecologists. (2016). Committee opinion no. 823. Health care for transgender and gender diverse individuals. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/03/health-care-for-transgender-and-gender-diverse-individuals
Azagba, S., Shan, L., & Latham, K. (2019). Overweight and obesity among sexual minority adults in the United States. International Journal of Environmental Research and Public Health, 16(10), 1828. https://doi.org/10.3390/ijerph16101828.
Baptiste-Roberts, K., Oranuba, E., Werts, N., & Edwards, L. V. (2017). Addressing health care disparities among sexual minorities. Obstetrics and Gynecology Clinics of North America, 44(1), 71–80. https://doi.org/10.1016/j.ogc.2016.11.003.
Becerra-Culqui, T. A., Liu, Y., Nash, R., Cromwell, L., Flanders, W. D., Getahun, D., Giammattei, S. V., Hunkeler, E. M., Lash, T. L., Millman, A., Quinn, V. P., Robinson, B., Roblin, D., Sandberg, D. E., Silverberg, M. J., Tangpricha, V., & Goodman, M. (2018). Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics, 141(5), e20173845. https://doi.org/10.1542/peds.2017-3845.
Benevento, J. (2019, October 23). What does the plus in “LGBT+” mean? https://www.statepress.com/article/2018/10/spartcult-what-is-the-plus-in-lgbt-plus
Boyd, C. J., Veliz, P. T., Stephenson, R., Hughes, T. L., & McCabe, S. E. (2019). Severity of alcohol, tobacco, and drug use disorders among sexual minority individuals and their “not sure” counterparts. LGBT Health, 6(1), 15–22. https://doi.org/10.1089/lgbt.2018.0122.
Brownstein, M., Madva, A., & Gawronski, B. (2020). Understanding implicit bias: Putting the criticism into perspective. Pacific Philosophical Quarterly, 101(2), 276–307. https://doi.org/10.1111/papq.12302.
Centers for Disease Control. (2020, April 1). Patient-centered care for transgender people: Recommended practices for health care settings. https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/affirmative-care.html
Deutsch, M. B. (2016). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. https://transcare.ucsf.edu/guidelines
Devine, P. G., Forscher, P. S., Austin, A. J., & Cox, W. T. L. (2012). Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. Journal of Experimental Social Psychology, 48(6), 1267–1278. https://doi.org/10.1016/j.jesp.2012.06.003.
Dune, T., & Liamputtong, P. (2019). Gender and sexuality as social determinants of health. In P. Liamputtong (Ed.), Social determinants of health (pp. 215–242). Melbourne: Oxford University Press.
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18, 19. https://doi.org/10.1186/s12910-017-0179-8.
Fredriksen-Goldsen, K. I., Kim, H., McKenzie, G. L., Krinsky, L., & Emlet, C. A. (2017). Plan of action for real-world translation of LGBTQ health and aging research. LGBT Health, 4(6), 384–388. https://doi.org/10.1089/lgbt.2017.0185.
Gawronski, B. (2019). Six lessons for a cogent science of implicit bias and its criticism. Perspectives on Psychological Science, 14(4), 574–595. https://doi.org/10.1177/1745691619826015.
Greene, M. Z., France, K., Kreider, E. F., Wolfe-Roubatis, E., Chen, K. D., Wu, A., & Yehia, B. R. (2018). Comparing medical, dental, and nursing students’ preparedness to address lesbian, gay, bisexual, transgender, and queer health. PLoS One, 13(9), e0204104. https://doi.org/10.1371/journal.pone.0204104.
Harbin, B., Roberts, L. M., Nelson, R., & Purcell, C. (2020). Teaching beyond the gender binary in the university classroom. Vanderbilt University Center for Teaching. Retrieved May 31, 2021, https://cft.vanderbilt.edu/guides-sub-pages/teaching-beyond-the-gender-binary-in-the-university-classroom/
Healthcare Bill of Rights/HealthLink. (n.d.). Healthcare bill of rights. Retrieved May 31, 2021. https://healthcarebillofrights.org/
Human Rights Campaign. (n.d.). Glossary of terms. Retrieved May 31, 2021. https://www.hrc.org/resources/glossary-of-terms
Human Rights Campaign Foundation. (2020). Healthcare Equality Index 2020. Promoting equitable and inclusive care for lesbian, gay, bisexual, transgender & queer patients and their families. https://reports.hrc.org/healthcare-equality-index-2020?_ga=2.141540786.1452751359.1616785365-1491737919.1606845936&_gac=1.26564687.1614095588.Cj0KCQiA7NKBBhDBARIsAHbXCB5e7VsZwdIe4vPDhjWB1vpHGFcMCP_KGoxlfC9Wfm0KVpz-IZnN2vcaAlKbEALw_wcB
Human Rights Watch. (2018). You don’t want second best: Anti-LGBT discrimination in US health care. https://www.hrw.org/sites/default/files/report_pdf/us_lgbt0718_web.pdf
Hyde, J. S., Bigler, R. S., Joel, D., Tate, C. C., & Anders, S. M. (2019). The future of sex and gender in psychology: Five challenges to the gender binary. American Psychologist, 74(2), 171–193. https://doi.org/10.1037/amp0000307.
ILGA World, Chiam, Z., Duffy, S., González Gil, M., Goodwin, L., Timothy, N., & Patel, M. (2019). Trans Legal Mapping Report 2019: Recognition before the law. Geneva: ILGA World, 2020. Retrieved May 31, 2021, https://ilga.org/downloads/ILGA_World_Trans_Legal_Mapping_Report_2019_EN.pdf
ILGA World, Mendos, L. R., Botha, K., Carrano, R., Enrique López de la Peña, L., Savelev, IL, & Tan, D. (2020). State-sponsored homophobia 2020: Global legislation overview update. Geneva: ILGA, December 2020. Retrieved May 31, 2021, https://ilga.org/downloads/ILGA_World_State_Sponsored_Homophobia_report_global_legislation_overview_update_December_2020.pdf
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people building a foundation for better understanding. www.iom.edu/lgbthealth
Koshy, K., Limb, C., Gundogan, B., Whitehurst, K., & Jafree, D. J. (2017). Reflective practice in health care and how to reflect effectively. International Journal of Surgery. Oncology, 2(6), e20. https://doi.org/10.1097/IJ9.0000000000000020.
Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14, 595. https://doi.org/10.1007/s10459-007-9090-2.
Martin, G., & Choporis, L. (2020, May 28). What are gender pronouns? Why do they matter?. National Institutes of Health Office of Equity, Diversity, and Inclusion. https://www.edi.nih.gov/blog/communities/what-are-gender-pronouns-why-do-they-matter
Mason, B. (2020, June 4). Curbing implicit bias: What works and what doesn’t. Knowable Magazine. https://knowablemagazine.org/article/mind/2020/how-to-curb-implicit-bias
Masters, C., Robinson, D., Faulkner, S., Patterson, E., McIlraith, T., & Ansari, A. (2019). Addressing biases in patient care with the 5Rs of cultural humility, a clinician coaching tool. Journal of General Internal Medicine, 34(4), 627–630. https://doi.org/10.1007/s11606-018-4814-y.
Mirza, S. A., & Rooney, C. (2018, January 18). Discrimination prevents LGBTQ people from accessing health care. Center for American Progress. https://www.americanprogress.org/issues/lgbtq-rights/news/2018/01/18/445130/discrimination-prevents-lgbtq-people-accessing-health-care/
Morris, M., Cooper, R. L., Ramesh, A., Tabatabai, M., Arcury, T. A., Shinn, M., Im, W., Juarez, P., & Matthews-Juarez, P. (2019). Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: A systematic review. BMC Medical Education, 19, 325. https://doi.org/10.1186/s12909-019-1727-3.
Murphy, M. J. (2019, December 20). “No, you can’t have my pronouns!” Asking for gender pronouns isn’t always progressive. https://emjaymurphee.medium.com/no-you-cannot-have-my-gender-pronouns-5b2f6b7e418a
Nadal, K. L., Whitman, C. N., Davis, L. S., Erazo, T., & Davidoff, K. C. (2016). Microaggressions toward lesbian, gay, bisexual, transgender, queer, and genderqueer people: A review of the literature. Journal of Sex Research, 53(4–5), 488–508. https://doi.org/10.1080/00224499.2016.1142495.
National Academies of Sciences, Engineering, and Medicine. (2020). Understanding the well-being of LGBTQI+ populations. Washington, DC: The National Academies Press. https://doi.org/10.17226/25877.
National LGBT Health Education Center. (2016, February 17). Providing inclusive services and care for LGBT people: A guide for health care staff. Fenway Institute. https://www.lgbthealtheducation.org/publication/learning-guide/
Nurse Practitioners in Women’s Health. (2018, March 9). Healthcare for transgender and gender non-conforming individuals. https://www.npwomenshealthcare.com/transgender-gender-non-conforming/
Pérez-Stable, E. (2016). Sexual and gender minorities formally designated as a health disparity population for research purposes. National Institute on Minority Health and Health Disparities. https://www.nimhd.nih.gov/about/directors-corner/messages/message_10-06-16.html
Project Implicit®. (n.d.). Education: About the IAT. Retrieved May 31, 2021. https://implicit.harvard.edu/implicit/iatdetails.html
Rocheleau, J. (2019, August, 21). A former slur is reclined, and listeners have mixed feelings. https://www.npr.org/sections/publiceditor/2019/08/21/752330316/a-former-slur-is-reclaimed-and-listeners-have-mixed-feelings
Sanders, J. (2009). The use of reflection in medical education: AMEE guide no. 44. Medical Teacher, 31, 685–695. file:///Users/ruud0024/Dropbox/Writing%20Projects/Book%20Chapter%20Cultural%20Humility/LGBT%20Chapter%20Revisions/Revision%20sources/ReflectionMEdicalEducation.pdf
Sexual and Gender Minority Research Office. (2019, August 28). Sexual and gender minority populations in NIH-supported research. National Institutes of Health. https://grants.nih.gov/grants/guide/notice-files/NOT-OD-19-139.html
Sukhera, J., Wodzinski, M., Rehman, M., & Gonzalez, C. M. (2019). The Implicit Association Test in health professions education: A meta-narrative review. Perspectives on Medical Education, 8, 267–275. https://doi.org/10.1007/s40037-019-00533-8.
Tamanna, Y. (2018, June 19). When did we start referring to ourselves as queer? i-D. https://i-d.vice.com/en_us/article/a3a89e/when-did-we-start-referring-to-ourselves-as-queer
Taylor, J. (2018, February 7). 3 in 5 people will deliberately misgender a trans person to show disrespect. LGBTQ Nation. https://www.lgbtqnation.com/2018/02/3-5-people-will-deliberately-misgender-trans-person-show-disrespect/
Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. https://doi.org/10.1353/hpu.2010.0233.
The Trevor Project. (2020). The Trevor Project national survey on LGBTQ youth mental health 2020. https://www.thetrevorproject.org/survey-2020/?section=Introduction
Veldhuis, C. B., Drabble, L., Riggle, E. D. B., Wootton, A. R., & Hughes, T. L. (2018). “I fear for my safety, but want to show bravery for others”: Violence and discrimination concerns among transgender and gender-nonconforming individuals after the 2016 presidential election. Violence and Gender, 5(1), 26–36. https://doi.org/10.1089/vio.2017.0032.
World Health Organization. (n.d.). Gender and health. Retrieved May 31, 2021. https://www.who.int/health-topics/gender#tab=tab_1
Yeager, K. A., & Bauer-Wu, S. (2013). Cultural humility: Essential foundation for clinical researchers. Applied Nursing Research, 26(4), 251–256. https://doi.org/10.1016/j.apnr.2013.06.008.
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Ruud, M. (2022). Using Cultural Humility in Care Provided for LGBTQ People. In: Liamputtong, P. (eds) Handbook of Social Inclusion. Springer, Cham. https://doi.org/10.1007/978-3-030-89594-5_115
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