Comparing Ways to Train Healthcare Clinic Staff to Ask Patients about Sexual Orientation and Gender Identity

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What was the research about?

Not all healthcare clinics document people’s sexual orientation and gender identity, or SOGI, in their health records. But knowing patients’ SOGI can help clinic staff, such as doctors and nurses, give high-quality care that respects the needs of sexual and gender minority, or SGM, patients. SGM is a term that is sometimes used for people who are lesbian, gay, bisexual, transgender, or queer. Quality care can include tailored health screenings and referrals for SGM patients based on SOGI.

In this study, the research team compared two ways to train clinic staff to improve their documentation of data on SOGI, health screenings, and referrals:

• A training program. The program had three parts. First, the team surveyed staff about how ready they were to document and talk about SOGI. Then, based on the survey results, the team gave tailored, in-person trainings on SGM health and how to document SOGI data in health records. Last, the team asked staff how likely they were to use what they learned.
• An optional webinar. Clinic staff could watch a one-hour online webinar on SGM health and documenting SOGI.

What were the results?

After two years, the number of clinics with improvements in documenting SOGI, preventive health screenings, and referrals didn’t differ between clinics that received the training program and those that received the optional webinar.

Who was in the study?

This study included 12 healthcare clinics in 10 states. Clinics served between 1,182 and 134,199 patients. In clinics, patients who identified as a sexual minority ranged from less than 1 percent to 59 percent. Patients who identified as a gender minority ranged from less than 1 percent to 17 percent.

What did the research team do?

The research team assigned clinics by chance to receive the training program or the optional webinar. In clinics that received the training program, 17 percent to 100 percent of staff attended trainings. Clinics held 2 to 10 trainings.

Over two years, the research team reviewed health records for SOGI data; data on preventive screening for depression, HIV, cancer, and other illnesses; and referrals to services based on screening results.

What were the limits of the study?

At the start of the study, documentation of SOGI and screening in health records differed across clinics. When clinics already documented SOGI for most patients, it was hard to see improvements from the program or webinar. Also, the number of trainings and staff who were trained differed widely. Results may have differed if trainings were similar across clinics. Researchers collected follow-up data during the COVID-19 pandemic. Disruptions in clinical care may have affected results.

Future research could continue to look at ways to improve consistent documentation of SOGI data.

How can people use the results?

Clinics can use the results when considering ways to improve their documenting of SOGI in health records.

Objective

To compare the effectiveness of a tailored training program on sexual and gender minority (SGM) populations versus an optional self-led webinar for healthcare clinic staff in improving documentation of sexual orientation and gender identity (SOGI) and rates of preventive health screening for SGM patients

Study Design

This randomized controlled trial compared the effectiveness of a tailored SGM training program versus an optional self-led webinar in increasing SOGI documentation and preventive health screening rates among SGM patients. Knowing patients’ SOGI can help staff at healthcare clinics provide high-quality care that respects the needs of SGM patients.

Researchers randomized 12 community healthcare centers to receive a training program focused on SGM populations or a self-led optional webinar. The three-part training program included a readiness assessment, educational interventions, and an evaluation of training sustainability. First, the needs assessment asked about healthcare staff’s perceived knowledge, attitudes, skills, practices, policies, and preparedness to care for SGM patients. Second, researchers delivered tailored educational trainings on providing health care to SGM patients and collecting SOGI data based on the needs identified in the assessment. Third, the evaluation asked staff how likely they were to implement what they learned. The self-led optional online webinar was one hour and focused on providing health care to SGM patients and collecting SOGI data.

The study included 12 healthcare centers in 10 states. Centers’ patient populations ranged from 1,182 to 134,199. Of these patients, the percentage of patients who identified as a sexual minority ranged from less than 1% to 59% and the percentage of patients who identified as a gender minority ranged from less than 1% to 17%. Across training program centers, 17%–100% of staff attended trainings. Centers held 2–10 trainings.

Staff from healthcare centers helped design this study.

Results

After two years, healthcare centers that received the training program and centers that received the self-led webinar did not differ significantly in increased:

• Documentation of sexual orientation data
• Documentation of gender identity data
• Rates of preventive screening services
• Referral rates

Limitations

Healthcare centers differed in their baseline levels of SOGI documentation. Some centers already had high levels of SOGI documentation at the start of the study, which may have made it challenging to detect differences between groups. Also, the number of trainings and the number of staff trained in the program differed widely in the six training program centers. Results may have differed if trainings were consistent across centers. Researchers collected follow-up data during the COVID-19 pandemic. Disruptions in clinical care may have affected results. 

Conclusions and Relevance

In this study, compared with an optional self-led webinar, the tailored SGM health training program did not increase SOGI documentation and preventive health screening rates for SGM patients.

Future Research Needs

Future research could continue to examine ways to improve SOGI documentation.