Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare Workers
Reducing the stigma and discrimination faced by men who have sex with men (MSM) and transgender women (TGW) in healthcare settings is key to improving health outcomes. Using a one-group pre- and post-test design, we tested the efficacy of a theory-informed, multi-level pilot intervention (“Harmony”)...
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MDPI AG
2023-07-01
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| Series: | Venereology |
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| Online Access: | https://www.mdpi.com/2674-0710/2/3/9 |
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| author | Venkatesan Chakrapani Smitha Nair Sudharshini Subramaniam Ketki Ranade Biji Mohan Ruban Nelson Sajeesh T. Sivaraman Murali Shunmugam Jasvir Kaur Shruta Rawat Theranirajan Ethirajan Chinmoyee Das Shobini Rajan Anoop Kumar Puri Bhawani Singh Kushwaha Bhawna Rao Utpal Das Vinita Verma Neha Kapoor |
| author_facet | Venkatesan Chakrapani Smitha Nair Sudharshini Subramaniam Ketki Ranade Biji Mohan Ruban Nelson Sajeesh T. Sivaraman Murali Shunmugam Jasvir Kaur Shruta Rawat Theranirajan Ethirajan Chinmoyee Das Shobini Rajan Anoop Kumar Puri Bhawani Singh Kushwaha Bhawna Rao Utpal Das Vinita Verma Neha Kapoor |
| author_sort | Venkatesan Chakrapani |
| collection | DOAJ |
| description | Reducing the stigma and discrimination faced by men who have sex with men (MSM) and transgender women (TGW) in healthcare settings is key to improving health outcomes. Using a one-group pre- and post-test design, we tested the efficacy of a theory-informed, multi-level pilot intervention (“Harmony”) among 98 healthcare workers (HCWs) to reduce sexual orientation and gender identity (SOGI)-related stigma and discrimination faced by MSM and TGW in two public hospitals. The intervention contained group-level (a half-day workshop) and individual-level (four videos) components. Using multi-level modelling, we compared knowledge, attitudes, and comfort level among HCWs across three timepoints: pre-intervention, post-intervention, and follow-up (2 months after the intervention). Client surveys were conducted among 400 MSM/TGW (two independent samples of 200 MSM/TGW) attending the intervention hospitals, before the intervention among HCWs and three months after the intervention. Generalised estimating equations assessed service users’ satisfaction with hospital services, discrimination experiences, and positive interactions with HCWs. Significant changes were observed in primary outcomes: 30% increase in positive attitude scores (incidence rate ratio (IRR) = 1.30, 95% CI 1.13–1.49) and 23% increase in the proportion of HCWs reporting being comfortable in providing care to MSM/TGW (IRR = 1.23, 95% CI 0.03–1.68). Similarly, there was a significant improvement in secondary outcomes (scores): support for non-discriminatory hospital policies (IRR = 1.08, 95% CI 1.004–1.15), the importance of asking SOGI questions in clinical history (IRR = 1.17, 95% CI 1.06–1.29), and perceived self-efficacy in providing clinical care (IRR = 1.13, 95% CI 1.01–1.27). Service users’ data provided corroborative evidence for intervention efficacy: e.g., 14% increase in the proportion of MSM reporting overall satisfaction with hospital services and 6% and 15% increase in the scores of positive interactions with HCWs in the combined sample of MSM/TGW and TGW, respectively. The Harmony intervention showed preliminary evidence for improving positive attitudes, comfort level, and understanding of the healthcare issues of MSM/TGW among HCWs, warranting large-scale implementation research. |
| first_indexed | 2024-03-10T21:52:41Z |
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| id | doaj.art-8d8ec2b840e5474eb3033e42c8d48a64 |
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| language | English |
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| publishDate | 2023-07-01 |
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| series | Venereology |
| spelling | doaj.art-8d8ec2b840e5474eb3033e42c8d48a642023-11-19T13:20:24ZengMDPI AGVenereology2674-07102023-07-01238610710.3390/venereology2030009Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare WorkersVenkatesan Chakrapani0Smitha Nair1Sudharshini Subramaniam2Ketki Ranade3Biji Mohan4Ruban Nelson5Sajeesh T. Sivaraman6Murali Shunmugam7Jasvir Kaur8Shruta Rawat9Theranirajan Ethirajan10Chinmoyee Das11Shobini Rajan12Anoop Kumar Puri13Bhawani Singh Kushwaha14Bhawna Rao15Utpal Das16Vinita Verma17Neha Kapoor18Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai 600101, IndiaTata Institute of Social Sciences (TISS), Mumbai 400088, IndiaInstitute of Community Medicine, Madras Medical College, Rajiv Gandhi Government General Hospital (RGGGH), Chennai 600003, IndiaTata Institute of Social Sciences (TISS), Mumbai 400088, IndiaThe Humsafar Trust, Mumbai 400055, IndiaCentre for Sexuality and Health Research and Policy (C-SHaRP), Chennai 600101, IndiaCentre for Sexuality and Health Research and Policy (C-SHaRP), Chennai 600101, IndiaCentre for Sexuality and Health Research and Policy (C-SHaRP), Chennai 600101, IndiaPostgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, IndiaThe Humsafar Trust, Mumbai 400055, IndiaInstitute of Community Medicine, Madras Medical College, Rajiv Gandhi Government General Hospital (RGGGH), Chennai 600003, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaNational AIDS Control Organisation (NACO), New Delhi 110001, IndiaReducing the stigma and discrimination faced by men who have sex with men (MSM) and transgender women (TGW) in healthcare settings is key to improving health outcomes. Using a one-group pre- and post-test design, we tested the efficacy of a theory-informed, multi-level pilot intervention (“Harmony”) among 98 healthcare workers (HCWs) to reduce sexual orientation and gender identity (SOGI)-related stigma and discrimination faced by MSM and TGW in two public hospitals. The intervention contained group-level (a half-day workshop) and individual-level (four videos) components. Using multi-level modelling, we compared knowledge, attitudes, and comfort level among HCWs across three timepoints: pre-intervention, post-intervention, and follow-up (2 months after the intervention). Client surveys were conducted among 400 MSM/TGW (two independent samples of 200 MSM/TGW) attending the intervention hospitals, before the intervention among HCWs and three months after the intervention. Generalised estimating equations assessed service users’ satisfaction with hospital services, discrimination experiences, and positive interactions with HCWs. Significant changes were observed in primary outcomes: 30% increase in positive attitude scores (incidence rate ratio (IRR) = 1.30, 95% CI 1.13–1.49) and 23% increase in the proportion of HCWs reporting being comfortable in providing care to MSM/TGW (IRR = 1.23, 95% CI 0.03–1.68). Similarly, there was a significant improvement in secondary outcomes (scores): support for non-discriminatory hospital policies (IRR = 1.08, 95% CI 1.004–1.15), the importance of asking SOGI questions in clinical history (IRR = 1.17, 95% CI 1.06–1.29), and perceived self-efficacy in providing clinical care (IRR = 1.13, 95% CI 1.01–1.27). Service users’ data provided corroborative evidence for intervention efficacy: e.g., 14% increase in the proportion of MSM reporting overall satisfaction with hospital services and 6% and 15% increase in the scores of positive interactions with HCWs in the combined sample of MSM/TGW and TGW, respectively. The Harmony intervention showed preliminary evidence for improving positive attitudes, comfort level, and understanding of the healthcare issues of MSM/TGW among HCWs, warranting large-scale implementation research.https://www.mdpi.com/2674-0710/2/3/9sexual and gender minoritiesIndiastigmadiscriminationhealthcare settingsmen who have sex with men |
| spellingShingle | Venkatesan Chakrapani Smitha Nair Sudharshini Subramaniam Ketki Ranade Biji Mohan Ruban Nelson Sajeesh T. Sivaraman Murali Shunmugam Jasvir Kaur Shruta Rawat Theranirajan Ethirajan Chinmoyee Das Shobini Rajan Anoop Kumar Puri Bhawani Singh Kushwaha Bhawna Rao Utpal Das Vinita Verma Neha Kapoor Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare Workers Venereology sexual and gender minorities India stigma discrimination healthcare settings men who have sex with men |
| title | Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare Workers |
| title_full | Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare Workers |
| title_fullStr | Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare Workers |
| title_full_unstemmed | Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare Workers |
| title_short | Efficacy of a Multi-Level Pilot Intervention (“Harmony”) to Reduce Discrimination Faced by Men Who Have Sex with Men and Transgender Women in Public Hospitals in India: Findings from a Pre- and Post-Test Quasi-Experimental Trial among Healthcare Workers |
| title_sort | efficacy of a multi level pilot intervention harmony to reduce discrimination faced by men who have sex with men and transgender women in public hospitals in india findings from a pre and post test quasi experimental trial among healthcare workers |
| topic | sexual and gender minorities India stigma discrimination healthcare settings men who have sex with men |
| url | https://www.mdpi.com/2674-0710/2/3/9 |
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