How to Provide Culturally Responsive Care to Gender-Diverse Communities
Published on Jan 17, 2023. Updated on Feb 16, 2023.
Today's Osmosis blog offers helpful tips and guidance on how doctors, nurses, and other caregivers can best provide culturally responsive care to patients across the gender identity spectrum.
Adapted from the Hippocratic oath, "first, do no harm" is a phrase that's well-known among both medical students and physicians. One of the ways to protect patients from harm is to be intentional about how you provide care to those who are different from you in ways that may be unfamiliar such as religious beliefs, sexuality, or gender identity.
Please refer to the short glossary of terms at the end of this article to help clarify any language that may be unfamiliar.
Let's talk about gender identity
Often used interchangeably in casual conversation, sex and gender are distinct from one another. A person's sex is assigned at birth based on physical and physiological features such as anatomy, genetics, and hormones. In contrast, how we perceive gender is based on how we internalize longstanding, socially constructed roles that have historically been limited to a binary of man/woman or boy/girl. However, there are notable exceptions, such as the Two Spirit people of the Zuni and Crow Nations, the Nguii, a third gender recognized by the Zapotecs, the Bakla in pre-colonial Philippines, or the Hijra in South Asia.
Gender identity is how we view ourselves internally and through our individual experiences with gender. A person's gender identity may be the same or different from their birth-assigned sex, may not be confined to a binary (man/woman or boy/girl), and could shift over time. There's a lot of diversity in how individuals and groups understand, experience, and express gender. It can be based on the roles they choose, the expectations placed on them, how they relate to others, and the complex ways that gender is regulated by society.
What is culturally responsive care?
Culturally responsive care intentionally recognizes, values, and respects all people. It requires healthcare professionals and caregivers to consider both sociocultural realities (how the world sees a person) and individual identities (how a person sees themself) when developing and delivering resources, education, and services.
Providing culturally responsive care is vital for people with diverse gender identities because they often feel alienated and misunderstood when seeking healthcare. When a gender-diverse individual seeks healthcare, even the most inclusive and responsive providers can unintentionally harm a patient by not understanding the structural and systemic barriers that have quietly shaped their outlook on gender. And it's an unfortunate fact that many gender-diverse people encounter healthcare providers who do not accept the existence of gender diversity, despite evidence to the contrary.
For many years, gender-diverse communities have faced hardships and discrimination in many areas of their lives. For example, until 2012, being transgender was considered a mental health disorder by the American Psychiatric Association (APA). And until 1993, there were no laws prohibiting discrimination against transgender people. Even today, some lawmakers are still debating the validity of transgender identities and gender diversity in spite of the overwhelming scientific evidence supporting the need for gender-affirming healthcare.
Even today, people with various gender identities often struggle to receive care on par with their cisgender peers. Recognizing that culturally responsive care needs to be improved for people in these communities is the first step to improving care.
Addressing Barriers to Healthcare for Gender-Diverse People
We all want an environment where we feel safe to express ourselves and seek care without fear of reprisal or judgment. To ensure this is the case, various systemic issues must be addressed at all levels of society, from government regulation to individual healthcare providers. The good news is that multiple organizations already offer education on culturally responsive care, including the U.S. Health and Human Services Office of Minority Health and the Alliance of Continuing Medical Education, and more are expanding their offerings daily.
To get an idea of how to help, a review published in the American Journal of Preventive Medicine describes five interventions that improve cultural competence in healthcare systems to help improve care for gender-diverse people:
Develop and implement programs to recruit and retain staff members who reflect the cultural diversity of the community served
Make the use of interpreter services or bilingual providers available for clients with limited English proficiency
Cultural competency training for all healthcare providers and caregivers
Use of linguistically and culturally appropriate health education materials
Creating culturally specific healthcare settings
Most importantly, there needs to be representation within healthcare systems because constructive change is far more likely to happen when people with diverse gender identities hold leadership roles and openly interact with the public.
How Providers Can Better Care for Gender-Diverse Patients
Many gender-diverse people find themselves with the additional burden of needing to teach their doctors about their bodies, specific health challenges, and identity. To relieve this burden from patients, physicians, and other healthcare professionals must be educated about gender-diverse care during medical school and throughout their medical careers.
When speaking to or about patients, healthcare providers should actively choose to use gender-inclusive language. For example, rather than saying "pregnant woman," practice using language such as "pregnant person." Another helpful practice is the consistent use of your own pronouns in your introduction to your patients and leaving space for them to share their stated pronouns at the beginning of the encounter as well.
To understand best practices, providers should refer to The World Professional Association for Transgender Health's Standards of Care for the Health of Transsexual, Transgender, and GenderNonconforming People. This thorough guide provides information on therapeutic approaches, epidemiologic considerations, lifelong primary care, and more for people of various gender-diverse communities.
Helping People in Gender-Diverse Communities Access Healthcare
Finding the courage to stand up for our healthcare needs can be challenging. For a gender-diverse patient, it's even more daunting due to concerns about discrimination and mistreatment. One way for patients to face those challenges and improve healthcare outcomes is to ask for help in the form of a patient advocate whose job is to help patients and their loved ones navigate the healthcare system.
Additionally, when patients enter your care, make it abundantly clear that they are in a safe and affirming space. Encourage them to ask questions and be receptive to any questions or concerns. And make sure to inform them that a patient advocate is available and that they have the right to choose a new provider without fear of retaliation.
Clinicians can further help gender-diverse communities by showing support for, engaging with, and providing care through community-based organizations such as LGBTQIA-focused community groups. Coming to people in their community can help break down that barrier to initial access that many people in gender-diverse communities face.
Resources for Clinicians Serving Gender-Diverse Communities
As a provider, it's important to recognize when you need more education and support to better serve your patients. To learn more about LGBTQIA+ issues in healthcare and gendered oppression, use these resources:
Lambda Legal's Survey on Discrimination Against LGBT People and People Living with HIV
The Joint Commission's Field Guide to Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community
Substance Abuse and Mental Health Services Administrations' Practitioner's Resource Guide: Helping Families to Support their LGBT Children
The World Professional Association for Transgender Health's Standards of Care for the Health of Transsexual, Transgender, and GenderNonconforming People
Keep these resources handy, and refer to them often to help you bridge the gap in treating gender-diverse patients.
Resources for People Looking for a Culturally Responsive Provider
For those looking for a physician who understands and supports gender-diverse communities, these resources can help:
GLMA: Health Professionals Advancing LGBTQ Equality's Provider Directory
World Professional Association for Transgender Health's Provider Directory Search
Gender-diverse people have faced barriers to healthcare for years, and while culturally responsive healthcare is more accessible today, they still face many obstacles. Providing quality care for all communities requires an intentional approach in a system designed to support and respect all people. Clinicians who provide culturally responsive care make healthcare access easier for all cultures and communities.
Proper education for providers before and during practice is essential, and providers should strive to create welcoming environments that encourage gender-diverse people to seek care. Genuinely compassionate care is a collaboration between the provider and patient, especially with culturally responsive care.
Glossary of Terms
Cis or Cisgender: of, relating to, or being a person whose gender identity corresponds with the sex the person had or was identified as having at birth.
Gender diversity: A gender expression that is different from cultural norms for that gender.
Gender dysphoria: Distress or extreme discomfort due to identifying as a different gender than one's gender assigned at birth. Only some gender-nonconforming people experience gender dysphoria at some point in their life.
Gender expression: A person's outward appearance or behavior as it relates to the gender others perceive them as being.
Gender identity: A person's internal feeling of being masculine/feminine, man/woman or boy/girl, neither, or an alternative gender or variation on existing gender expression.
Gender nonconforming: An adjective describing somebody whose gender identity or expression does not conform with their assigned sex at birth.
LGBTQIA+: Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic/agender. (Tip: A does not stand for Ally.)
Transgender: People whose gender identity differs from their assigned sex. They may or may not use medical assistance to transition to a different sex.