196. “It’d Be Great To Have The Options There”: Adolescent Impressions of Gender Identity Collection On Forms In A Primary Care Clinic

Abstract

Transgender adolescents and young adults experience substantial barriers to health care, which may exacerbate existing health inequities. Adding questions about gender identity to clinic intake forms have been shown to improve access to and quality of care for adult transgender patients. However, there is a need to translate these efforts to adolescent health care settings. This quality improvement project sought to determine acceptability and feasibility of routine collection of gender identity from adolescent medicine patients using self-administered forms in the medical practice at the time of visit. We interviewed fourteen adolescents (ages 15-23 years; mean age=19 years) from March 2018 through June 2018. We adapted the recommended two-step method of gathering gender identity information for use in an adolescent clinic. Cisgender (i.e., non-transgender) and transgender adolescents were recruited from an urban adolescent medicine clinic in the Northeast United States. Participants completed a brief cognitive interview regarding their impression of four proposed gender affirming questions to be added to an existing paper form handed to patients in the waiting room at their annual preventive visit. The questions addressed name (“what name should we use for you?”), pronouns (“what pronouns should we use for you?”), gender identity, and sex assigned at birth. Interview recordings were transcribed verbatim; two investigators reviewed transcripts and conducted thematic analysis to identify acceptability, question clarity, and concerns. Participants were cisgender (cisgender male n=3; cisgender female n=4) and transgender (transgender male n=4; transgender female n=1; non-binary/genderqueer n=2) and 8 of 14 were people of color. Nearly all participants reported being comfortable or had no major concerns about the proposed questions. Several themes emerged from the analysis. First, both transgender and cisgender adolescents discussed benefits of the proposed questions for all patients (“honestly, I think it’d be great to have the options on there” – cisgender male, age 20; “I think that’s very appropriate to making everyone ultimately comfortable when coming here” – transgender male, age 18). Second, transgender and non-binary patients described specific benefits (“’Preferred name’ demeans the name you’ve chosen for yourself, so I like this [better]” – transgender male, age 17). Third, some participants discussed issues of confidentiality (“…putting this on a paper I might be a little paranoid, but I’m not actually that worried.” – transgender male, age 18), while others emphasized confidentiality was not a concern. Some participants identified strategies for building on the gender questions to further improve care (e.g., providers stating their own pronouns when introducing themselves). Name, pronoun, and gender identity questions were understandable and well-received by patients. Collecting gender identity information prior to a patient visit is an option that busy adolescent medicine clinics should consider. Future research is needed to determine acceptability in other practice settings or geographic regions and whether collecting this information leads to improved patient-provider communication about gender identity as it relates to adolescent health.