Transgender Athletes' Experiences With Health Care in the Athletic Training Setting.

CONTEXT: The term transgender refers to individuals whose gender identity does not match their sex assigned at birth. Transgender people often report negative health care experiences, leading many to avoid seeking care. The experiences of transgender athletes with athletic trainers (ATs) are currently unknown. OBJECTIVE: To describe common experiences they have had with ATs and to identify barriers transgender athletes may encounter when seeking care. DESIGN: Qualitative phenomenologic study. SETTING: Individual phone interviews. PATIENTS OR OTHER PARTICIPANTS: Nine transgender participants from high school (n = 2), collegiate (n = 4), club (n = 2), and semiprofessional (n = 1) athletics (age = 23.56 ± 5.32 years). Participants were either current athletes or had been athletes within the past 5 years. They consisted of transgender men (n = 3), transgender women (n = 3), and nonbinary or genderqueer people (n = 4), with 1 participant identifying as both a transgender man and nonbinary. DATA COLLECTION AND ANALYSIS: Participants completed semistructured phone interviews that addressed positive and negative experiences, avoidance, and perceived AT knowledge of transgender concerns. The interviews were analyzed for themes and evaluated with a peer reviewer. Member checking was conducted to validate the findings. RESULTS: Three main themes emerged. Education described ATs' knowledge of transgender concerns and receptiveness to learning. Primacy of the patient addressed ATs' behaviors when interacting with transgender athletes. Environment involved how social environments affected transgender athletes' comfort with ATs. Participants commonly perceived a lack of clinician education on transgender needs, which combined with a lack of support or hostile environment to lead to discomfort and avoidance. Respecting privacy, demonstrating support, and being open to education led to positive experiences. CONCLUSIONS: Athletic trainers can improve their care of transgender athletes in several areas. Information about transgender people should be included in athletic training curriculums. Athletic trainers can also use inclusive language, signal that facilities are safe for all, and be familiar with resources for transgender athletes.

Development of an Instrument to Assess Athletic Trainers' Attitudes Toward Transgender Patients.

CONTEXT: The unique contexts in which athletic trainers (ATs) work require specific tools in order to understand their attitudes toward diverse patient populations, including sexual and gender minorities. OBJECTIVE: To develop and validate the Attitudes Toward Transgender Patients (ATTP) instrument for ATs. DESIGN: Cross-sectional study. SETTING: Semistructured interviews, paper-based questionnaire, and electronic questionnaire. PATIENTS OR OTHER PARTICIPANTS: Six ATs completed semistructured interviews to develop themes regarding transgender patients. Additionally, 39 students in professional and postprofessional athletic training programs answered questionnaires designed to elicit statements regarding transgender patients. For item reduction, a sample of 3000 ATs were e-mailed (response rate = 17%), and for validation, another sample of 3000 ATs were e-mailed (response rate = 13%). Athletic trainers' e-mail addresses were obtained from the National Athletic Trainers' Association. DATA COLLECTION AND ANALYSIS: The 3 phases were (1) exploratory interviews, (2) construct validity and item reduction, and (3) criterion validity. Items were created based on interviews and questionnaires. Principal axis factoring was used for item reduction, and Pearson correlations were used for validation. RESULTS: Thirty-six statements pertaining to transgender patients were developed from the interview and questionnaire data. After item reduction, 10 items remained to form the ATTP (α = .834). For validation, the ATTP and Transphobia Scale were significantly correlated ( r = .723; P < .001). CONCLUSIONS: The ability to assess attitudes toward transgender patients will allow clinicians to identify needed areas of focus for training and education. The ATTP assesses affective and cognitive attitudes and behavioral intentions toward transgender patients in common clinical settings.

Athletic trainers' attitudes toward lesbian, gay, and bisexual National Collegiate Athletic Association student-athletes.

CONTEXT: Researchers have investigated heterosexuals' attitudes toward homosexuals, focusing on factors such as sex, race, religion, education, and contact experiences. However, in the context of sport, this research is deficient. We found no published literature investigating athletic trainers (ATs') attitudes toward lesbian, gay, and bisexual student-athletes (LGB). OBJECTIVE: To determine heterosexual ATs' attitudes toward LGB student-athletes in the National Collegiate Athletic Association. DESIGN: Cross-sectional study. SETTING: E-mailed survey. PATIENTS OR OTHER PARTICIPANTS: A total of 964 ATs employed at member institutions. MAIN OUTCOME MEASURE(S): We measured attitudes using the Attitudes Toward Lesbian, Gay Men, and Bisexuals (ATLGB) Scale. To determine the extent to which sex, religion, and whether having an LGB friend or family member had an effect on ATs' attitudes, we performed analysis of variance. To establish the effect of age on ATs' attitudes, we calculated a Pearson correlation. We used an independent t test to identify differences between ATs who reported working with LGB student-athletes and ATs who did not. RESULTS: With ATLGB score as the dependent factor, a main effect was noted for sex, religion, and having an LGB friend or family member (P < .01 for all comparisons). Age and total score were related (P < .01). A difference was seen in the ATLGB scores between ATs who were aware of LGB student-athletes on their teams and ATs who were not (P < .001). CONCLUSIONS: Many ATs hold positive attitudes toward LGB student-athletes, especially females, those who have an LGB friend or family member, and those who are aware of LGB student-athletes. Still, it is important to provide an open environment in the athletic training room for all student-athletes.