Communicating with health providers and romantic partners: The impact of negative emotions on quality of life for individuals with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease that impacts an estimated 1 to 4% of the population; women are twice as likely to be diagnosed as men. There is no cure for HS, and many patients face a lifetime of various healthcare appointments, medical interventions, and personal experiences living with the disease. Objective: This study aimed to explore social, emotional, and medical experiences for individuals with HS, and to understand connections between those experiences and quality of life. Methods: Participants (n = 243) in the community-based convenience sample completed a cross-sectional survey about their experiences and quality of life and reported high rates of anxiety, embarrassment, and depressed mood. These and other negative emotions were commonly experienced during interactions with healthcare providers and romantic partners. Results: Participants who had more negative interactions with providers and partners surrounding their HS tended to experience a lower quality of life. Limitations: Limited generalizability due to convenience sampling. Conclusion: Providers should consider how patients experience patient -provider communication about HS, and how this communication impacts other areas of patients' lives, including quality of life, mental health, and romantic relationships. Future care approaches should prioritize mental health strategies in HS patients' care plans, and establish partnerships between dermatology practices and mental health professionals to aid in the multidisciplinary approach recommended for the treatment of HS.

"I just felt supported": Transgender and non-binary patient perspectives on receiving transition-related healthcare in family planning clinics.

Transgender and non-binary people face challenges in accessing gender affirming hormone therapy. Family planning clinics across the United States have greatly expanded transgender care services in the last ten years offering increased access to these services. This national qualitative study describes transgender and non-binary patients' experiences of receiving transgender care in family planning clinics. We completed 34 in-depth interviews with transgender and non-binary people over age 18 who had received transition-related care at a family planning clinic in the last year from 2019-2020. We analyzed interview data in Dedoose using constant comparative analysis and inductive thematic analysis. Patients reported overwhelmingly positive experiences at family planning clinics and were especially surprised at the ease and speed of the informed consent process. Barriers to care remain for patients in rural areas, low income patients, and patients who need specialized care. Some of the barriers relate to the gender binary and transphobia built into the medical systems, which cause patients and providers to have to find "work arounds" the binary medical and insurance systems. Patients also shared their idealized visions of transition related care that center on strong referral networks and hiring of LGBTQ staff at the clinics. Family planning clinics currently provide affirming and supportive care, especially those that use the informed consent model. Family planning clinics could provide increased access to transgender healthcare outside of major metropolitan areas and for transgender and gender non-conforming clients across the lifespan.

Clinic Staff Perspectives on Barriers and Facilitators to Integrating Transgender Healthcare into Family Planning Clinics.

Purpose: Although some research exists about transgender and nonbinary people's reproductive health needs, little research has explored the expansion of transgender health care in a family planning clinic context. This study investigates the expansion of transition-related care in family planning clinics in the United States from the perspective of clinic staff members. Methods: Between 2018 and 2019, 25 in-depth interviews with family planning clinic staff across the United States explored themes in incorporation and continuation of transgender care. Qualitative data were also collected at several national reproductive health professional conferences in sessions focused on transgender health care. Content analysis on the type of care available at clinics from public websites was analyzed using descriptive statistics. Results: Family planning clinics became invested in offering transition related care through existing patient requests and community requests, including from staff members themselves. Clinics faced administrative and scheduling challenges in adding care. They reported that medical protocol components were easiest to learn. Analysis of clinic websites indicates that ∼10% of nationally networked clinics offer transgender care compared to 21% of independent member clinics of the Abortion Care Network. Conclusions: Family planning clinics should consider adding transgender care based on patient or community demand as an extension of existing expertise in providing patient-centered care. Clinics should be aware that tool kits and protocols already exist to support integrating transition related care in family planning clinics.

"The Ones that Care Make all the Difference": Perspectives on Student-Faculty Relationships.

Student-faculty (S-F) interactions that are conducive to students' learning can help reduce the retention and graduation gaps in higher education, especially for college students from underrepresented and underprivileged backgrounds. The aim of the study was to explore students' perceptions of their interactions with faculty, and the subjective impact of these interactions on students' academic and personal life. We analyzed qualitative data from a larger study with the goal of providing best practice models to support students experiencing displacement and food insecurity. Through purposive sampling techniques, 53 students from a diverse public university were recruited. Recruitment strategies focused on students who were likely to be facing academic, personal, and/or financial challenges that may affect their academic performance. Students were interviewed three to four times over a four to six-month period, using semi-structured interview guides. Our multidisciplinary team analyzed data thematically in team-based coding sessions using an online software. We identified four themes for faculty practices: (1) Creating Pedagogical Space, (2) Being Inclusive and Aware, (3) Being Engaged and Engaging Students, (4) Doing More Than Teaching. Based on students' perspectives, these practices lead to supportive and responsive S-F relationships that facilitate learning and success. The findings have implications related to how faculty can encourage caring S-F relationships and create conducive learning environments where students can thrive, especially during times of crisis.

Medical conditions, pregnancy perspectives and contraceptive decision-making among young people: an exploratory, qualitative analysis.

OBJECTIVE: To explore perspectives on family planning among young people who perceive they are infertile or will have difficulty carrying a pregnancy to term owing to medical conditions or procedures. METHODS: This exploratory analysis examined pregnancy plans and contraceptive behavior among 12 young adults with a diagnosed medical condition or who had undergone a medical procedure associated with impaired fertility, and who had discussed fertility with a healthcare provider. We utilized data from a larger study investigating prospective pregnancy intentions and plans among 50 young (ages 18-24) women and their male partners (n=100). RESULTS: Medical conditions included endometriosis, polycystic ovary syndrome, and lupus. For some, medical conditions/procedures led to use of no or less effective contraception; perceived risk for pregnancy was low, though seven participants had previously experienced pregnancies. Participants also described how medical conditions altered their timelines for pregnancy and overall desire for children; for example, one participant described continuing an unplanned pregnancy because she feared it would be her only chance to parent. CONCLUSION: This exploratory analysis suggests that among young people, medical issues perceived to affect fertility and pregnancy may influence pregnancy planning and contraceptive behavior. Young people may lack knowledge about fertility and the impact of a medical condition; thus it is critical that providers clarify the difference between anticipated difficulty conceiving and complete infertility. Tailored contraceptive care is needed for young adults with medical conditions that may affect fertility to ensure they have the necessary information to make informed family planning decisions. IMPLICATIONS: Medical conditions known to affect fertility may influence young people's family planning desires and behaviors. Understanding how young adults process information about medical conditions' impact on their fertility and change or make plans in response is important in order to best meet their family planning needs.

Perceptions of body size and health among older queer women of size following participation in a health programme.

Little research examines how older queer (lesbian and bisexual) women understand and construct meanings around their body size in the context of individual and community norms and identities. Grounded theory was used to analyse transcripts from 31 interview participants drawn from a health programme in the San Francisco Bay Area. Older queer women of size navigate tensions between body ideals and community ideals in and through their experiences of body size. Women's embodied experiences of fatness, chronic pain and weight changes shifted in tandem with their experience of interactions with other queer women, as well as what bodies and body ideals should be in 'the lesbian community'. This study found that bodily norms and health ideologies are embedded and embodied in communities and navigated through the ongoing formation and configuration of communities over time. Body acceptance movements may be out of touch for this population based on their internalisation of the medical model in which weight loss automatically means improved health. Health interventions for older, queer women of size must be community-based to effectively shift behaviours, norms and expectations around healthy living in fat, ageing bodies.

Inclusion of LGBTQ persons in research related to pregnancy risk: a cognitive interview study.

INTRODUCTION: Recently, researchers have begun considering whether and how to include lesbian, gay, bisexual, transgender and queer (LGBTQ) people in research about abortion and contraception care. Including LGBTQ people in research about abortion and contraception care, as well as the risk for unintended pregnancy more broadly, requires accurate assessment of risk for unintended pregnancy, which involves different considerations for LGBTQ people. METHODS: We created a survey with existing sexual orientation and gender identity measures, new reproductive anatomy questions to guide skip patterns, gender neutral terminology in sexual and behavioural risk questions, and existing contraception and pregnancy intentions questions that were modified to be gender neutral. We then assessed the appropriateness of these measures through cognitive interviews with 39 individuals aged 18-44 years who were assigned female at birth and identified as LGBTQ. Participants were recruited in the San Francisco Bay Area of California, Baltimore, Maryland and other cities. RESULTS: Existing demographic questions on sexual orientation and gender identity were well received by participants and validating of participant reported identities. Participants responded positively to new reproductive anatomy questions and to gender neutral terminology in sexual behaviour and pregnancy risk questions. They felt skip patterns appropriately removed them out of inappropriate items (eg, use of contraception to avoid unintended pregnancy); there was some question about whether pregnancy intention measures were widely appropriate or should be further restricted. CONCLUSIONS: This study provides guidance on ways to appropriately evaluate inclusion of LGBTQ people in abortion and contraception research.

It's Not Planned, But Is It Okay? The Acceptability of Unplanned Pregnancy Among Young People.

BACKGROUND: It is well-established that current measures of pregnancy intentions fail to capture the complexity of couples' lived experiences and decisions regarding reproductive decision making. Despite limitations, these measures guide programs, policy, and clinical practice. Herein, we explore prospective pregnancy acceptability, which captures whether individuals anticipate considering an unexpected pregnancy welcomed, manageable, or okay. METHODS: Individual qualitative interviews were conducted with 50 young (ages 18-24 years) women and their male partners (N = 100) to elucidate prospective pregnancy desires and perspectives on pregnancy planning. Using a thematic approach, we analyzed data from a subsample (n = 88) of participants who did not currently desire a pregnancy. RESULTS: Despite lack of pregnancy desire, 37 participants indicated that a pregnancy would be acceptable. Several themes emerged as reasons for pregnancy acceptability, including feeling prepared for children, relational stability, having knowledge of what it takes to parent, and taking a "whatever happens" approach toward pregnancy planning. Notably, a number of reasons for pregnancy acceptability were also described as reasons for lack of acceptability. For example, although many parents in the sample found pregnancy acceptable owing to their knowledge of the time and resources that raising children required, other parents found pregnancy unacceptable for this same reason. CONCLUSIONS: Acceptability captures nuances of prospective views on pregnancy and what it means for young people's lives that current intentions language and framing often neglects. Additionally, acceptability may be a construct that resonates with the perspectives and lives of young people for whom the notion of active pregnancy planning is not salient.

Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study.

BACKGROUND: Little research documents the self-identified reproductive health priorities and health care experiences of lesbian, gay, bisexual, transgender, queer (LGBTQ)-identified individuals who may be in need of services. METHODS: We conducted in-depth interviews with a diverse sample of 39 female-assigned-at-birth individuals (ages 18-44) who also identified as lesbian, bisexual, queer, and/or genderqueer, or transmasculine. Interviews were primarily conducted in person in the Bay Area of California, and Baltimore, Maryland, with 11 conducted remotely with participants in other U.S. LOCATIONS: We asked participants about their current reproductive health care needs, topics they felt researchers should pursue, and past reproductive health care experiences. Data were analyzed using a framework method, incorporating deductive and inductive thematic analysis techniques. RESULTS: Reproductive health care needs among participants varied widely and included treatment of polycystic ovary syndrome and irregular menses, gender-affirming hysterectomies, and fertility assistance. Many faced challenges getting their needs met. Themes related to these challenges cross-cutting across identity groups included primary focus on fertility, provider lack of LGBTQ health competency relevant to reproductive health priorities and treatment, and discriminatory comments and treatment. Across themes and identity groups, participants highlighted that sexual activity and reproduction were central topics in reproductive health care settings. These topics facilitated identity disclosures to providers, but also enhanced vulnerability to discrimination. CONCLUSIONS: Reproductive health priorities of LGBTQ individuals include needs similar to cisgender and heterosexual groups (e.g., abortion, contraception, PCOS) as well as unique needs (e.g., gender affirming hysterectomies, inclusive safer sex guidance) and challenges in pursuing care. Future reproductive health research should pursue health care concerns prioritized by LGBTQ populations.

Women's Health and Mindfulness (WHAM): A Randomized Intervention Among Older Lesbian/Bisexual Women.

INTRODUCTION: Lesbian and bisexual (LB) women have higher body weight than heterosexual women. Interventions focused on health and well-being versus weight loss may be more likely to succeed among LB women. This article describes effects of Women's Health and Mindfulness, a 12-week pilot intervention addressing mindfulness, healthy eating, and physical activity, on outcomes associated with chronic disease risk among overweight and obese LB women older than 40 years. METHOD: Eighty women were randomized, using a stepped-wedge design, to either an immediate- or a delayed-start intervention group; the delayed-start group served as the control. Eligible participants were aged 40 years or older, identified as LB, and had a body mass index of 27 or greater. We compared differences in biological markers of chronic disease, mindfulness, nutrition, and physical activity between immediate- and delayed-start intervention groups. RESULTS: We observed clinically significant improvements in low-density lipoprotein cholesterol but no change in hemoglobin A1c. We found evidence of intervention effects on improved mindfulness and mindful eating scores and on nutrition (improved vegetable intake). CONCLUSIONS: The Women's Health and Mindfulness pilot intervention appears to have initiated positive behavioral and physical health changes in this population. Refinements to the intervention model, such as extended intervention duration, and longer term follow-up are warranted to determine sustained effects.

Two Tailored Provider Curricula Promoting Healthy Weight in Lesbian and Bisexual Women.

PURPOSE: Provider curricula to reduce potential weight bias or stigma in treating lesbian and bisexual (LB) women who are overweight or obese were pilot-tested in two unique settings. Trainings used LB cultural competency and motivational interviewing techniques to improve provider-patient interactions. METHODS: Two training formats were used: Clinic Format and Academic Format. Clinic Format training was pilot tested at Lyon-Martin Health Services, a Program of HealthRight360, a community health center serving women, lesbians, and transgender people in San Francisco and in two community settings. Academic Format training was pilot tested by the Mautner Project of Whitman-Walker Health with physicians, medical residents, and students at Georgetown, George Washington, Howard, and Vanderbilt Universities. Both programs measured provider knowledge and attitude change. RESULTS: Both programs saw significant percentage point gains in knowledge about LB women's avoidance of health care based on body size. Participants in the Academic Format program saw the greatest gain in knowledge about understanding health care avoidance (30 percentage point increase), whereas Clinic Format program participants gained most in understanding how to appropriately discuss weight loss with patients (23 percentage point increase). CONCLUSIONS: Both programs increased provider knowledge about the barriers to health care facing LB women who are overweight and obese, reducing the potential for future negative interactions. However, the two programs differed in how they conceptualized the relationship between weight and health, likely contributing to differences in knowledge gain among participants at each site. Future studies should test differences between the two formats across site type or staff baseline knowledge differences.

Recruitment and Participation of Older Lesbian and Bisexual Women in Intervention Research.

BACKGROUND: Very little research has addressed issues of recruitment and participation of lesbian and bisexual (LB) women, aged 40 and older, into research studies. This study is based on a larger cross-site intervention study that recruited women from five geographic regions in the United States for culturally specific LB healthy weight programs, lasting 12 or 16 weeks. METHODS: Principal investigators (PIs) of the five intervention programs completed a questionnaire on recruitment and participation strategies and barriers. Participant data on completion and sociodemographic variables were compiled and analyzed. RESULTS: The recruitment strategies the programs' PIs identified as most useful included word-of-mouth participant referrals, emails to LB participants' social networks, and use of electronic health records (at the two clinic-based programs) to identify eligible participants. Flyers and web postings were considered the least useful. Once in the program, participation and completion rates were fairly high (approximately 90%), although with varying levels of engagement in the different programs. Women who were younger or single were more likely to drop out. Women with disabilities had a lower participation/completion rate (82%) than women without any disability (93%). Dropouts were associated with challenges in scheduling (time of day, location) and changes in health status. CONCLUSIONS: Implementation of key strategies can improve both recruitment and participation, but there is a great need for further study of best practices to recruit and promote participation of LB women for health intervention research.

Effects of Mindfulness Interventions on Health Outcomes in Older Lesbian/Bisexual Women.

PURPOSE: Lesbian and bisexual (LB) women are at higher risk for obesity, but no reported interventions focus on older LB women who are overweight or obese. The Healthy Weight in Lesbian and Bisexual Women study funded five programs (n = 266 LB women age ≥40); two examined effects of mindfulness interventions on health outcomes. METHODS: Analysis of variance and regression measured the impact of mindfulness-based programs on health behaviors and quality of life (MCS). Outcomes were also compared between intervention sites (mindfulness vs. standard weight loss approaches). RESULTS: Mindful Eating Questionnaire (MEQ) subscale scores improved significantly from preassessment to postassessment in mindfulness interventions. LB women who reported an increase (top tertile) in mindful eating had the most significant increase in MCS scores (35.3%) compared with those with low gains (low and medium tertile) in mindfulness (3.8%). MEQ score increase predicted 40.8% of the variance (adjusted) in MCS score, R(2) = .431, F(6,145) = 18.337, p < .001. Top tertile increases in mindfulness were significantly related to increases in physical activity and some nutrition outcomes. Mindfulness intervention sites showed within-person improvements in MCS and fruit and vegetable intake, whereas standard intervention sites showed within-person decreases in alcohol intake and increases in physical activity level. CONCLUSIONS: Although weight loss was not a primary outcome at the mindfulness sites, small but significant weight loss and weight-to-height ratio decreases were reported at all five sites. Increases in mindfulness were associated with a number of significant self-reported health improvements, including a great increase in perceived mental health quality of life. Mindfulness may be a promising practice to address health issues in aging LB women.

Program Design for Healthy Weight in Lesbian and Bisexual Women: A Ten-City Prevention Initiative.

PURPOSE: Adult lesbian and bisexual (LB) women are more likely to be obese than adult heterosexual women. To address weight- and fitness-related health disparities among older LB women using culturally appropriate interventions, the Office on Women's Health (OWH) provided funding for the program, Healthy Weight in Lesbian and Bisexual Women (HWLB): Striving for a Healthy Community. This paper provides a description of the interventions that were implemented. METHODS: Five research organizations partnered with lesbian, gay, bisexual, and transgender community organizations to implement healthy weight interventions addressing the needs of LB women 40 years and older. The interventions incorporated evidence-based recommendations related to physical activity and nutrition. Each group intervention developed site-specific primary objectives related to the overall goal of improving the health of LB women and included weight and waist circumference reduction as secondary objectives. A 57-item core health survey was administered across the five sites. At a minimum, each program obtained pre- and post-program assessments. RESULTS: Each program included the OWH-required common elements of exercise, social support, and education on nutrition and physical activity, but adopted a unique approach to deliver intervention content. CONCLUSION: This is the first time a multisite intervention has been conducted to promote healthy weight in older LB women. Core measurements across the HWLB programs will allow for pooled analyses, and differences in study design will permit analysis of site-specific elements. The documentation and analysis of the effectiveness of these five projects will provide guidance for model programs and future research on LB populations.

A systematic review of the literature on weight in sexual minority women.

BACKGROUND: Over the past 20 years, a growing literature has demonstrated that sexual minority women have greater weight than heterosexual women, prompting concern that they may be at high risk for disparities in physical disorders. In 2008, Bowen et al. published a review of the existing research on sexual minority women and obesity, finding no methodologically strong studies with representative sampling procedures. METHOD: We conducted a systematic review of the literature covering the period of July 2006 to February 2014 on the relationship between sexual orientation and weight. The review includes 20 population-based and 17 nonprobability sample studies. CONCLUSIONS: The majority of these studies found that lesbian and bisexual women had significantly greater body mass index (BMI) or a higher percentage with a BMI over 30 than heterosexual women. The difference in BMI was fairly consistent across the lifespan, with the weight differences beginning in adolescence. The studies, however, did not show a higher prevalence of physical disorders thought to be associated with weight. This potentially paradoxical finding warrants further research to compare prevalence of chronic disease by BMI category and sexual orientation.

Aging, Weight, and Health Among Adult Lesbian and Bisexual Women: A Metasynthesis of the Multisite "Healthy Weight Initiative" Focus Groups.

PURPOSE: Adult lesbian and bisexual (LB) women are more likely to be obese than adult heterosexual women. Achieving a healthy weight reduces health risks and improves quality of life, but the evidence based on successful weight interventions is limited. To inform a national initiative, a metasynthesis (a form of qualitative meta-analysis) of focus group data was conducted to gather lesbian and bisexual womens' perspectives. METHODS: Analysis used de-identified transcripts and narrative reports from 11 focus groups guided by different semi-structured discussion guides with 65 participants from five locations. A literature search was conducted to identify existing themes in published literature and unpublished reports. RESULTS: Six key themes were identified: aging; physical and mental health status; community norms; subgroup differences; family and partner support; and awareness and tracking of diet and physical activity. Participants expressed feeling unprepared for age-related changes to their health and voiced interest in interventions addressing these issues. Their perspectives on community acceptance of body size shifted as they aged. Participants cited age, class, race, ethnicity, sexual identity, and gender expression as potential characteristics that may influence participation in interventions. Families were both a barrier to and a facilitator of health behaviors. Awareness and tracking of dietary habits, stressors, and physical activity levels emerged as a theme in more than half of the groups. CONCLUSION: An unsolicited, overarching theme was aging and its influence on the participants' perspectives on health and weight. Interventions should be tailored to the needs, goals, and community norms of LB women.

Prior family planning experiences of obese women seeking abortion care.

BACKGROUND: The prevalence of obesity among women of reproductive age calls for research focused on strategies that ensure obese women receive high-quality reproductive health care. This study adds to this literature on service delivery by exploring obese women's experiences receiving or avoiding family planning care. METHODS: We included 651 women seeking abortion care who completed iPad surveys about their previous family planning experiences. FINDINGS: One quarter were classified as obese, with almost 5% morbidly obese. Only 1% of obese women reported avoiding family planning care. More than 12% of morbidly obese women reported not having their family planning needs met (Pap smears, sexually transmitted infection testing, or ultrasonography). This is compared with only 2% among overweight and obese women and 0% among normal and underweight women. Almost 10% of obese and morbidly obese women reported that at least one of the previous family planning clinics they had visited was not prepared to provide care for heavier women and around 25% of obese women reported at least one item in the clinic (such as blood pressure cuffs and examination gowns) was not adequate for their size. RESULTS: Contrary to expectations, we did not find that obese women avoided family planning care. However, morbidly obese women reported not having all of their family planning needs met when they attended care. Family planning providers should ensure that their facilities have the capacity to meet the family planning needs of obese women and that they have adequate equipment to care for this population of women.