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'But is it feasible?’ Perceived barriers to implementing community feedback from marginalized populations for a novel sexual health clinic among healthcare providers

Martina, Jamie D (2023) 'But is it feasible?’ Perceived barriers to implementing community feedback from marginalized populations for a novel sexual health clinic among healthcare providers. Master's Thesis, University of Pittsburgh. (Unpublished)

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PURPOSE: Harm reduction is a proven approach for reducing adverse health, social, and behavioral outcomes, (e.g. lowering incidence rates of HIV, insecure housing, and substance use disorders)among people who exchange sex and transgender individuals. Community collaboration with sex workers and transgender individuals is a key step for healthcare professionals to understand specific wrap-around care needs in order to achieve optimal health outcomes for this population. This qualitative study seeks to understand a group of healthcare professionals’ perceptions of barriers after they received community feedback on what to prioritize in a novel sex and gender health clinic that meets marginalized communities’ specifications.
METHODS: Employees at a U.S. hospital’s inclusive health center who are on the planning committee of a developing sexual and gender health clinic centering care around people who exchange sex and people who identify as transgender, were interviewed after seeing a sex worker community advisory board’s list of recommendations for the clinic. COM-B behavioral change model was used to classify perceived barriers and facilitators to implement suggestions
RESULTS: Out of six COM-B components, one third of all barriers were coded as Social Opportunity barriers. The most coded for domain within Social Opportunity was operational & procedural requirements.
CONCLUSION: Hospitals, despite having well-established operational structures, greater funding, and more personnel, are still widely perceived as untrustworthy sites among marginalized patient groups, compared to community health clinics. Hospital systems may be resistant to change or are slow to adopt new practices. Furthermore, dated and entrenched operational systems are less modifiable to meet the needs of vulnerable patient groups. Therefore, a hospital network may not be the ideal entity to erect a clinic specifically for patient groups that face the most marginalization, particularly sex workers and transgender individuals. The public health significance of this research addresses a critical need for hospital administrations to examine how their policies impede progress toward equitable and accessible care among marginalized patient groups. This analysis aims to encourage other similarly resourced hospitals to assess their own operational procedures’ potentiality to inhibit change, and to seek collaboration opportunities with groups that have experience in implementing marginalized populations’ feedback.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Martina, Jamie Djdm216@pitt.edujdm2160000-0001-8628-8639
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCoulter, Robert
Committee MemberHawk, Marymary.hawk@pitt.edumeh960000-0001-9753-4356
Committee MemberPatella-Rey, PJpaprey@pitt.edupaprey0000-0003-3619-5316
Committee MemberDocumet, Patriciapdocumet@pitt.edupdocumet0000-0001-5943-4389
Committee MemberKislovskiy, Yasaswip.yasaswi@gmail.com0000-0001-5519-5894
Date: 15 May 2023
Date Type: Publication
Defense Date: 12 April 2023
Approval Date: 15 May 2023
Submission Date: 2 May 2023
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 67
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: No
Uncontrolled Keywords: health equity, institutional behavior change
Article Type: Research Article
MeSH Headings: Health Services Accessibility; Feasibility Studies
Date Deposited: 15 May 2023 22:01
Last Modified: 01 Jun 2023 15:42


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