Project Summary

Background: Transgender is a broad term often used to describe individuals whose gender self-identification or expression transgresses established gender norms. Specifically, it is the state of one’s internal gender identity (male, female, both or neither) not matching one’s designated sex at birth (identification by others as male or female based on chromosomal or anatomic sex).

Transgender people experience inequities that stem from discrimination, stigma, harassment, poverty, and lack of transgender-specific health information. The Williams Institute estimates 1.337 million adults in the United States identify as transgender, including 92,900 adults in Texas. Improving transgender health care requires dissemination projects to translate patient-centered outcomes research/comparative clinical effectiveness research (PCOR/CER) results into practice.

Primary dissemination of PCOR/CER results is left up to the research team that completed the PCOR/CER project. Community dissemination is vital since 24 percent of trans people reported "they had to teach their healthcare provider about transgender people to get appropriate care.” Reducing the time to disseminate PCOR/CER results to the transgender community and the other 10 intersectoral collaborator/stakeholder groups is essential to improving the community’s health outcomes.

Proposed Solution to the Problem: This project builds on Texas Health Institute (THI)’s Transgender and Gender Diverse (TGD)-focused infrastructure created over the past five years. In their first Engagement Award Project, the project team developed methods and processes to continuously engage members of the TGD community. The project team was able to build trust in medical research by demonstrating how the participation of the TGD community made their evidence visible and part of the evidence-based research record. They learned the importance of community guidelines and have applied these in each of the in-person and virtual meetings. 

The COVID-19 Enhancement Award demonstrated that in-person methods and processes could be translated into virtual meetings. Most importantly, the project team learned the safe spaces created for TGD people to share their lived experiences brought forth information they had not previously shared, even with significant others. This information identified gaps in the research literature.

THI’s second Engagement Award is built on the lessons learned and practices developed in the first award. The project team looked specifically at how COVID-19 impacted TGD people in the areas of mental health, employment, housing, and the virus itself. They identified what worked and what didn’t in how public health departments approached vaccine distribution and messaging to this population.

Throughout both Engagement Awards the project team learned the importance of having TGD people lead from the beginning and throughout the entire process. TGD people are responsible in large part for educating their clinicians, payers, employers, and other stakeholder groups about their health using current and emerging evidence-based research results. The project team intends to harness the desire for new knowledge in the TGD community and channel their lived experience into rapidly disseminating new PCOR/CER results into the 11 stakeholder groups. They base this on learnings from their past work and the PCORI-funded PCOR/CER research projects they are involved with.

As a result, the project team has a large community of TGD people and members of nine of the 11 stakeholder groups who have built trust and engagement through their work. They believe they can add the remaining two stakeholder groups at the outset and move forward with a Leadership Team, Core Dissemination Advisory Panel (Core DAP) and a larger Dissemination Advisory Panel (DAP) to convene listening sessions for each of the 11 stakeholder types. The results will be synthesized at a Capstone Convening as they were in the previous two Engagement Awards. Project outputs will be generated from this work.

The overarching objective is to build capacity and infrastructure for PCOR/CER results to be shared back with the communities that are the intended beneficiaries of these efforts. This will help plug a systemic gap around current research efforts, especially community-based participatory research that engage communities and patients on the front end and during the research with significant dissemination gaps developing after the research has been completed. This project offers a unique and strategic opportunity for THI to build capacity for the case for the full research cycle — from building PCOR/CER capacity, conducting PCOR/CER and disseminating results of PCOR/CER widely to collaborating partners or stakeholder groups. THI uses a project organizational structure similar to its previous two Engagement Awards to manage milestones and deliverables. This includes a Leadership Team providing primary project collaborative leadership. The Core DAP provides additional expansive guidance and expertise by representing 11 types of stakeholder groups. These team members are the voices for the stakeholder groups and bring additional understanding of their unique audiences. The DAP provides additional “boots on the ground” representation for the 11 stakeholder groups. The members assist in recruiting Listening Session participants and connecting with audiences internal to their stakeholder group. Listening Sessions Participants provide additional perspectives, insight and clarity as a participant representing internal audiences in one of the 11 stakeholder groups. This leads to creating a sustainable Dissemination Network. The Network provides a group of people who are interested and willing to actively share and disseminate TGD PCOR/CER evidence-based results within their stakeholder group.

Activities: The steps, or activities, to accomplish the primary objective and meet the goals are: 

  1. Establish a 16-person Leadership Team, a 28-person Core DAP and a 51-person DAP to guide the project over 24 months. 
  2. Identify emerging practices, frameworks, processes and lessons learned in disseminating PCOR/CER results in the LGBTQ+ community. 
  3. Host and facilitate 60-minute Listening Sessions with seven people in each of the 11 stakeholder (collaborator) groups to identify and understand specific audiences, partners, needs, reach and adoption requirements, health literacy and impairment practices and incentives to act or bring about change. 
  4. Convene the Capstone Dissemination Summit to formalize the Dissemination Network, determine how to enhance accessibility and usability of the evidence and identify stakeholders who can influence adoption among end users. 
  5. Create dissemination tools and resources to be shared publicly as a result of the Summit’s priorities.

Short-term outcomes during the project period:

  1. Establish a systemic framework and network infrastructure to disseminate TGD-focused CER findings. 
  2. Create tools and resources including processes and collaborator-informed practices. 
  3. Develop frameworks that demonstrate disseminated results can be integrated into clinical practice, health policy and curriculum.

Medium-term outcomes (0-2 years post-project period):

  1. Provide technical assistance to influence adoption of dissemination processes, tools, and resources among end users. THI provides technical assistance to several Centers for Disease Control and Prevention projects through the National Network of Public Health Institutes. THI has technical assistance capabilities from working with partners to extend technical assistance to organizations interested in using processes, tools and resources developed in this project.
  2. Develop methods to measure dissemination reach and TGD-focused CER results inclusion in practice, policy, and curriculum. THI has an exceptional research and evaluation team. Creating evaluation instruments to measure dissemination reach and time to reach audiences could be developed based on this project’s work.

Long-term outcomes (3+ years post-project period): THI’s long-term goal is to create culturally competent care improving the lives of TGD people. Health care that is accessible, affordable, and culturally competent is essential to fostering resilience and promoting overall well-being. 

The long-term outcomes THI and its partners will continue working on after the project concludes are:

  1. Improve lives using measurable outcomes demonstrating increases in TGD community quality of life with emphasis on BIPOC people.
  2. Improve lives using measurable outcomes in selected quality of life, well-being, health care, mental health, employment and housing respondent answers in the US Transgender Survey and other surveys. 
  3. Improve lives by reducing suicidal ideation and suicide attempts.

Patient and Stakeholder Engagement Plan: This dissemination capacity building project is based on THI’s and the earlier TGD work dating back to 2018. It includes using the PCORI Engagement Rubric and PCOR Principles as a key part of the foundation. A Key Stakeholder Matrix was created at the outset. The project leadership team includes 18 people, 11 of whom have multiple PCORI project experience. The Core DAP includes 28 people, 17 from earlier PCORI projects. The goal is at least 50 percent from the LGBTQ+ community with the majority TGD people. The 51-person Dissemination Advisory Panel expands knowledge & experiences with people from 11 collaborator groups. A goal is 65 percent from the LGBTQ+ community with the majority TGD people. All levels will include racially diverse and multi-generational people.

Project Collaborators: The University of North Texas Health Science Center School of Public Health: Stacey Griner, Ph.D. and Malinee Neelamegam, Ph.D., MPH. Consultants: M. Brett Cooper, M.D., M.Ed., FAAP; Jamison Green, Ph.D., MFA; Emmett Schelling; Ricardo Martinez, M.S.; Rocky Lane; Phillip Schnarrs, Ph.D.; Lindsay Rosenfeld, ScD, ScM; and Christopher Owens, Ph.D.

Project Information

Ankit Sanghavi, MPH, BDS
Texas Health Institute
$248,886

Key Dates

November 2025
2023

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Project Status
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 3, 2024