Personal Confidence Research Articles

’Prepare yourself’: Testing the literacy skills of graduating teachers

The 2016 introduction of national literacy and numeracy exit testing for all Australian teacher graduates was a significant policy decision that adds further pressure on the tightly regulated area of Initial Teacher Education. There are implications to examine from this specific mandate about the nature of the testing, the capabilities of future teachers, and contemporary conceptions of literacy. Initial Teacher Educators of literacy also need to consider how they might address the preparation of their preservice students to satisfy the test requirements while extending them beyond meeting one achievement measure to fulfil their career ambitions. This paper explores the impact of the policy regulation on preservice teachers, specifically, in relation to their personal literacy skills and test preparedness. Against this background of legislative requirements, the project reported here adopted one approach to address students’ literacy needs by developing customised online literacy support. Research conducted with the first cohort of participants to evaluate this intervention had two purposes. First, to obtain students’ evaluation of the online resource and their assessment of its usefulness as a tool for their learning. Secondly, to gather students’ views about their confidence in their personal literacy skills, and their opinions about the introduction of the LANTITE literacy test (ACER, 2019). The self-reported data prompt further discussion about the preparation of Initial Teacher Education students and the nature of literacy development for beginning teachers. There are ongoing challenges for teacher educators as we prepare our future teachers for professional accreditation that requires the demonstration of a specific set of skills. Literacy competency and linguistic achievement cannot be assumed. It is essential to build rich contemporary conceptualisations of literacy, to develop tertiary students’ personal and professional confidence across a range of multiliteracy practices and multimodalities, and to extend these well beyond any single test measure.

Interobserver and intraobserver agreement on prostate-specific membrane antigen PET/CT images according to the miTNM and PSMA-RADS criteria.

In this study, we aimed to measure interobserver and intraobserver agreement in Ga-68-prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) image interpretation. In addition, the limitations of these criteria and levels of personal confidence reported by the readers when reporting the findings were determined. The effects of interpersonal differences on clinical decisions were also investigated. PSMA PET images from 133 cases were reported independently by four different readers at different times according to the molecular imaging TNM (miTNM) and PSMA-reporting and data system (RADS) templates. There was substantial interobserver agreement for overall positivity, miT, miN and miM staging (Fleiss' κ = 0.65, 0.625, 0.731, and 0.779). Substantial agreement levels were observed in reporting of seminal vesicle invasion, the number of lymph node stations with metastasis, total number of intraprostatic areas containing tumors, and lymph node metastasis staging (Fleiss' κ = 0.622 and 0.779). The highest variation was seen in the reporting of intraprostatic distribution: In International Society of Urological Pathology (ISUP) grade group 1, moderate agreement was observed, and it was seen that the agreement level for the T staging increased with an increasing ISUP group in the staging group (Fleiss' κ = 0.531 vs. 0.655). There was near-perfect interobserver agreement in the reporting of five-point PSMA-RADS scoring [intraclass correlation coefficient (ICC) κ = 0.904; 95% CI, 0.865-0.934]. Disagreement according to miTNM staging had a major effect on clinical management in only 9% (n = 12) of the patients. PSMA PET has a lower interobserver variability and higher reproducibility than other imaging methods used for imaging of prostate cancer do, including CT, MRI, and bone scintigraphy. The miTNM template provides a reporting format that is highly reproducible and has a high level of agreement among readers, but the prostatic template needs development. In contrast, the PSMA-RADS system leads to slightly increased interobserver reporting differences and reduces personal confidence, but at the same time, it still exhibits almost-perfect agreement in terms of scoring.

Delegation of Home Visits and Qualification of Health Care Assistants in Family Practices in Saxony, Germany - Results of the Cross-Sectional Study SESAM-5

In the context of demographic changes and the shortage of family physicians in the primary care sector in Germany, the delegability of home visits to health care assistants is discussed. There is little information on the extent of home visits delegated. The aim of this article is to examine differences in the socio-demographic and organizational profile of delegating vs. non-delegating family doctors in Saxony and to describe the level of qualification of health care assistants. This cross-sectional study is part of a series of epidemiological studies in the federal state of Saxony, Germany. All family doctors in Saxony were contacted in 2014 (n=2677), of whom 11,2% participated. In a period of 12 months, family practices documented home visits within a randomly assigned week. Socio-demographic characteristics of the family practice and the level of qualification of health care assistants were surveyed. A total of 274 family practices participated; 52,9% of all participating family doctors declared their willingness to delegate home visits, but only 8,5% of home visits were made by health care assistants. There were non-significant trends between the willingness to delegate and self-employment vs. being employed (92,4 vs. 84,6%, p=0,06), establishment in a single vs. shared practice (35,2 vs. 31,4%, p=0,09) and higher patient numbers per 3 months (x̄+= 1183,08 vs. 1092,16, p=0,07). The 224 health care assistants that participated in the study were mostly trained in nursing (39,7%) or as medical assistants (50,8%). The vast majority of the health care assistants (82,5%) had no further training or additional qualification; 19,6% completed further training that qualified them to have home visits formally delegated to them. Among family doctors in Saxony there is a reported high willingness to delegate, which is not implemented sufficiently in practice. Delegation is based on personal confidence in health care assistants without formal qualification. Qualified delegation ensures high standards in patient care and this potential is not used in Saxony, particularly in rural areas with imminent shortages of medical care. More education about the opportunities of qualified delegation seems necessary.

Undergraduate research as a student engagement springboard: Exploring the longer-term reported benefits of participation in a research conference

ABSTRACTBackground: Undergraduate research is evident in many forms across higher education: in journals, at conferences and on research placements. It is widely reported that undergraduate research can encourage the development of discipline-specific and transferable communication skills and, in some cases, a more complex development of higher-order critical appraisal. Recent studies of extracurricular undergraduate research conferences have also found that participants report a development of self-authorship and an appreciation of the conference as liminal and transformative space. With many published studies measuring immediate feedback surrounding conference events, there is also a need to explore participants’ reflections over a longer term period of time.Purpose: This small-scale project investigated participants’ self-report of whether and in what ways participation in a non-assessed, extracurricular undergraduate research conference had impacted their academic and professional practices, one year after their involvement in the conference.Method: The qualitative study took place over two academic years with participants from an undergraduate conference which was held annually. The investigation adopted an action research methodology and completed two cycles of research. Data were collected firstly through an online survey with open questions, yielding feedback from 44 respondents. Focus groups were then conducted with nine of these students to explore this data further. A thematic approach was used to analyse the data.Findings: The two cycles of data collection and analyses resulted in the identification of four central themes: (1) general positive impact on studies or career; (2) the development of presentation skills and personal confidence; (3) the development of research skills and perspectives; (4) an increased engagement with extracurricular opportunities.Conclusions: Overall, our analysis identified that participants reported a development in communication skills and an enhanced relationship with the concept of ‘research’ and self-authorship. Students’ report that participation directly led to increased engagement with additional extracurricular activities is particularly noteworthy, as it contributes something new to the growing body of literature surrounding undergraduate research. More widely, the study suggests the potential for undergraduate conferences to act as springboards for increased extracurricular engagement.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

Explaining the impact of consumer religiosity, perceived risk and moral potency on purchase intentions

The role of religion has been overlooked as an antecedent to risk perception, as has moral potency, when purchasing religiously sensitive products. The aim of this study is to demonstrate how perceived risk and moral potency explain the impact of shopper religiosity on purchasing religiously-questionable products from retailers. A conceptual model was tested on a sample of 271 respondents, elucidating the complex relationships between religiosity, social and psychological risk, moral potency and purchase intention. The model offers a strong psychological explanation of how a shopper's religion may increase their perceptions of risk and personal responsibility, confidence and courage, which subsequently impact purchase intentions. Retail managers may choose to implement this model to better predict shopper adoption behaviour of new religiously-questionable products. The model allows for future empirical examinations across multiple shopping contexts and may be employed to estimate levels of demand for new products based on the extent of religiosity, moral potency and risk.

The implementation and evaluation of a resilience enhancement programme for nurses working in the forensic setting.

This study aimed to implement and evaluate a work-based personal resilience enhancement intervention for forensic nurses. A mixed methods design consisting of surveys, interviews, and a case study approach, whereby the experiences of a group of nurses were studied in relation to their experiences of an intervention programme to enhance personal resilience, was utilized. Nurses working on forensic inpatient wards were invited to participate. Senior nurses were recruited as mentors. Data were collected via pre- and post-programme surveys to evaluate nurses' levels of resilience. Post-programme interviews were undertaken with nurses and mentors to explore their experiences of the programme. Descriptive statistics of survey data examined changes in nurses' resilience levels pre- and post-intervention. Free-text survey data and interview data were analysed thematically. The SQUIRE 2.0 checklist was adhered to. Twenty-nine nurses participated. Levels of personal resilience (M=4.12, SD=0.60) were significantly higher post-programme than pre-programme (M=3.42, SD=0.70), (t49=3.80, P=0.000, 95% CI=0.32, 1.07). Nurses felt the programme had a marked impact on their personal resilience, self-awareness, confidence, and professional relationships. The benefits of the programme demonstrate the advantages of providing a nurturing environment for nurses to consolidate their resilience levels. Findings demonstrated that resilience enhancement programmes can increase nurses' levels of resilience and confidence and improve inter-professional relationships. Our findings are important for clinicians, nurse managers, and policymakers considering strategies for improving the workplace environment for nurses. The long-term impact of resilience programmes may improve nurse retention and recruitment.

Hotel Restaurant Service Employees’ Sources of Positive and Negative Emotions

ABSTRACT Focusing on hotel restaurant service employees, this study aims to explore sources of positive and negative emotions. Through a qualitative approach, both field observation and interviews are applied. Two of the authors firstly conduct field observation through an internship at hotel restaurants. Then, semi-structured interviews are completed with questions collected from the literature review. After a three-step inductive content analysis, this study proposes five first-order sources in positive emotion that includes customer interactions, manager leadership, coworker support, personal confidence and achievement, and restoration and leisure. Nine first-order sources in negative emotion are extracted that include workplace miscommunication, destructive managerial leadership, kitchen trouble, poor task management, inadequate remuneration, career development problems, conflicts with personal relationships, customer service problems, and problems in leisure and health. The findings of this study reveal that the complexity and the structure for sources of positive and negative emotions are largely different.

Determining Physical Therapists' Readiness for Integrating Yoga Therapeutics into Rehabilitation.

The positive health effects of yoga have led physical therapists (PTs) to integrate elements of the discipline into their treatments in some settings. Formal PT education includes limited, if any, training in yoga, and there is no system in place to provide education on safely implementing therapeutic yoga (TY) as an adjunctive treatment approach. The purposes of this study were to: (1) assess the readiness of PTs (those who do not currently prescribe TY to patients) to integrate TY into treatment, and (2) determine the feasibility of a 5-week online TY training to improve the readiness of PTs to utilize TY in their practices. Licensed PTs (n = 103) were recruited nationally through social media and email. Eligible and consented PTs registered for a 5-week online TY training course. PTs' perceptions of TY and the role of safety and confidence in prescribing TY to patients were measured at baseline and postintervention. Feasibility outcomes were measured after completion of the course. Benchmarks included: (1) > 70% of PTs would find the course acceptable; (2) > 60% would finish the course; and (3) there would be significant improvements in PTs' perceptions of TY. A total of 95 eligible PTs consented and registered for the course, with 60 (63.1%) completing the intervention. Prior to the training, most PTs felt they were not ready (n = 19/60, 31.7%) or somewhat ready (n = 25/60, 41.7%) to integrate TY. More than half thought the online training was acceptable (n = 50/60, 83.3%) and finished the course (n = 60/95, 63.1%). There were significant improvements in personal readiness and confidence to safely prescribe TY, current understanding/knowledge of TY, and feeling adequately trained to use some form of TY with patients. A 5-week online TY training course is feasible to deliver for improving PTs' readiness to prescribe TY. Future studies are proposed to test the effectiveness of TY training and education with PTs.

Design Attributes for Adaptive Tool’s Innovation in Rehabilitation Setting: A Scoping Research

Innovation in rehabilitation represents creative design which involve adaptive tool (AT) for patients in the occupational therapy department. Earlier, an online survey on innovative activities among OT has been conducted on thirty Malaysian occupational therapists. Findings indicate that 80% of the occupational therapists innovate new tools during rehabilitation. The purpose of this study is to identify design attributes of AT as issues highlighting the low rate of AT usage based on several factors; non-compliance, uncomfortable design, insufficient instruction and training, and also due to user’s personality i.e. lack of personal acceptance and confidence in using AT. A scoping review of 20 relevant literatures related to the usage, effectiveness and barriers of AT are drawn widely from the rehabilitation journal in the period between 1968 – 2018, and from design psychology journals to support the findings. A summary of each themes that has been highlighted from this review are AT prescribe factors, AT equipment factors and AT education factors. This review suggests that future research for creative activities in rehabilitation shall be provided with design consideration in order to bring better AT creation. The implications of these findings for the effects of innovation are discussed.

Developing the Role of the Clinical Academic Nurse, Midwife and Allied Health Professional in Healthcare Organisations

Clinical academics provide key contributions to positive outcomes in the delivery of high-quality health and social care; however, building capacity and capability for these roles for Nurses, Midwives and Allied Health Professionals (NMAHPs) within contemporary healthcare settings is often complex and challenging. Accessing funding and training, such as that provided by the National Institute for Health Research (NIHR), can remain beyond the reach of NMAHPs at point-of-care delivery because of limited structural empowerment, practical support and a culture inhibiting the growth of clinical academic careers. This article will discuss strategic developments and partnerships from two organisations, both with a positive track record of supporting clinical academic career development for NMAHPs. We aim to provide practical and applicable examples showing how NMAHPs have been supported from foundational to post-doctoral level and outline these under three key headings: strategic commitment; structures to engage, enthuse and empower clinical academic careers; and realising the benefits for staff and patient experience. We contend that a wide-ranging level of support is required to encourage aspiring clinical academics to navigate this complex journey, often where the development of personal confidence, and access to early career models combining clinical and research activity are pivotal. We conclude that when crafted and created effectively with sustainable commitment by organisations, NMAHP clinical academics provide an innovative workforce solution with the knowledge and skills essential for a contemporary NHS healthcare system.

A Tribute to Richard M. Crooks on the Occasion of His 65th Birthday

A Tribute to Richard M. Crooks on the Occasion of His 65th Birthday

Pathways to Recovery among Homeless People with Mental Illness: Is Impulsiveness Getting in the Way?

Objective:This study investigates the association between impulsiveness and six dimensions of recovery among homeless people with mental illness.Method:The sample was composed of 418 participants of a randomized controlled trial of Housing First, a recovery-oriented program that provides immediate access to permanent housing. The reliable change index method was used to provide an estimate of the statistical and clinical significance of the change from baseline to 24 months (i.e., clinically meaningful improvement), on outcomes that pertain to recovery dimensions: psychiatric symptoms (clinical), physical health and substance use problems (physical), residential stability (functional), arrests (criminological), community integration (social), and hope and personal confidence (existential). We tested for the effect of impulsiveness, assessed with the Barratt Impulsiveness Scale–11, on clinically meaningful improvement on each specific outcome, adjusting for age, gender and intervention assignment, as both intervention arms were included in the analysis.Results:For every increase in total impulsiveness score by one standard deviation, the odds of experiencing clinically meaningful improvement decreased by 29% (OR = 0.71, 95% CI, 0.55 to 0.91) on the clinical dimension and by 53% (OR = 0.47, 95% CI, 0.32 to 0.68) on the existential dimension. However, changes in outcomes pertaining to physical, functional, criminological, and social dimensions were not significantly influenced by impulsiveness.Conclusions:Findings highlight the importance of addressing impulsiveness in the context of recovery-oriented interventions for homeless people with mental illness. Further research may be required to improve interventions that are responsive to unique needs of impulsive individuals to support clinical and existential recovery.

HOW MULTIPLE CHRONIC DISEASE BURDEN INFLUENCES COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAM PARTICIPANTS

Background: Studies have shown that participation in community-based self-management education programs can result in improved healthful behaviors (exercise, cognitive symptom management, coping, and communications with physicians), improved health status (self-reported health, fatigue, disability, social/role activities, and health distress), and decreased days in the hospital. Problem: One of the understudied factors thought to influence efficacy in community based self-management programs is the presence and impacts of multiple chronic conditions on participants within community based behavioral health program populations. Multiple chronic diseases when scaled collectively can be considered as a participant’s individual disease burden to be included in other analyses. Methodology: This investigation explores possible ways disease burden associates with such important constructs as participant personal characteristics and participant confidence in controlling impacts of their disease symptoms and participant preferences for use of various methods of coping with disease impacts. Outcomes: Results indicate a complex pattern of relationships between such factors as personal characteristics of program participants and their perceived mastery over the impacts of their disease symptoms, and their preferred mechanisms for coping. Implications: program designers and managers can better understand the differential influences of disease burden on participants analyzed with their personal characteristics and their preferential uses for coping mechanisms and their perceived ability to withstand the added burdens of multiple chronic diseases.

Multidisciplinary Software Design for the Routine Monitoring and Assessment of Pain in Palliative Care Services: The Development of PainCheck

PURPOSEThe use of health information technology (HIT) to support patient and health professional communication is emerging as a core component of modern cancer care. Approaches to HIT development for cancer care are often underreported, despite their implementation in complex, multidisciplinary environments, typically supporting patients with multifaceted needs. We describe the development and evaluation of an e-health tool for pain management in patients with advanced cancer, arising from collaboration between health researchers and a commercial software development company.METHODSWe adopted a research-led development process, involving patients with advanced cancer and their health professionals, focusing on use within real clinical settings. A software development approach (disciplined agile delivery) was combined with health science research methods (ie, diary studies, face-to-face interviews, questionnaires, prototyping, think aloud, process reviews, and pilots). Three software iterations were managed through three disciplined agile delivery phases to develop PainCheck and prepare it for use in a clinical trial.RESULTSFindings from development phases (inception, elaboration, and construction) informed the design and implementation of PainCheck. During the transition phase, where PainCheck was evaluated in a randomized clinical trial, there was variation in the extent of engagement by patients and health professionals. Prior personal experience and confidence with HIT led to a gatekeeping effect among health professionals, who were reluctant to introduce PainCheck to patients. Patients who did use PainCheck seemed to benefit, and no usability issues were reported.CONCLUSIONHealth science research methods seemed to help in the development of PainCheck, although a more rigorous application of implementation science methodologies might help to elucidate further the barriers and facilitators to adoption and inform an evidence-based plan for future implementation.

Investigating career guidance implementation between historically advantaged and disadvantaged schools

This study examined school learner views on career guidance processes and outcomes contrasting historically advantaged and disadvantaged schools in the Free State province, South Africa. The study comprised 430 learners from seven schools located in the Mangaung area (females = 63.9%, black people = 47.4%, mean age = 15.85, SD = 0.77). A survey was completed underscoring career guidance service delivery, personal growth, career path knowledge and subject satisfaction. Multivariate analysis of variance was computed to examine differences in learners’ perception of the career guidance they received, emphasising school type, besides controlling for selected demographic variables. Results indicated that school type statistically significantly influenced career guidance service delivery, personal growth and career path knowledge gained from career guidance, but not subject satisfaction. Moreover, a statistically significant interaction for type of school with gender and race as covariates, and personal confidence and subject satisfaction as dependent variables, emerged.

Student perception on the integration of simulation experiences into human physiology curricula.

A variety of medical simulators have been developed over recent years for students of all medical professions. These simulators serve to teach basic science concepts, advanced clinical skills, as well as empathy and student confidence. This study aimed to understand the students' perception of the integration of high-fidelity simulation exercises into the teaching of human physiology. Research groups were made up of both osteopathic and podiatric medical students. Data were obtained using a Likert-scale survey. Results indicated that students believed the simulation experiences were beneficial to further understanding of physiological concepts, as well as seeing these concepts in a clinical setting. Variations were noted between podiatric and osteopathic medical students' perception on how the experiences helped them develop clinical and personal confidence, and if the experience helped illustrate correlations between laboratory values and accompanying physiology. Results illustrated no differences in perception between the sexes. Although all students agreed that the experience helped with the understanding of physiology, podiatric medical students did not necessarily find value in the simulation for their development as future clinicians. We predict that differences in perception are largely based on the different curriculums of the students questioned. The present study indicated that incorporation of simulation experiences in the first year of medical school enhanced learning basic science physiology concepts and promoted the development of self-confidence as future clinicians. Incorporating simulation into the didactic coursework should be promoted in other medical schools' curricula.

Perceptions of Sexual Harassment in Oral and Maxillofacial Surgery Training and Practice

Despite increased awareness of sexually harassing behavior (SHB) and national movements such as #MeToo, SHB remains a persistent problem for women training in medical and surgical fields. The aims of the present study were to 1) estimate the prevalence and nature of SHBs in a set of female oral and maxillofacial surgery (OMS) residents and practicing surgeons in the United States; 2) measure and describe the subjective effects of SHBs on the professional development of female OMSs; and 3) measure the effect of SHB education in training programs and its association with its prevalence. A cross-sectional study was conducted using an adapted validated Sexual Experiences questionnaire. The 22-question survey was e-mailed to female members of the American Association of Oral and Maxillofacial Surgeons' women's clinical interest group. Descriptive statistics and bivariate analyses were computed using age and SHB training as predictor variables for the prevalence of SHBs. A total of 89 participants were e-mailed, and 67 responded (75%). Of the 67 respondents, 53 were practicing OMSs (79%) and 14 were OMS residents (21%). Of the 67 respondents, 96% had experienced at least 1 form of SHB. Specifically, 96% reported gender harassment, 52% unwanted sexual attention, and 9% sexual coercion. An "intimidating, hostile, or offensive environment" was associated with "having a negative effect on yourself as a professional" (P<.01). Of the respondents, 61% had not received education on SHBs during training, with those older than 35years least likely to have received SHB training (P=.001). Our results have shown that SHBs received by female OMSs is common. Our findings suggest that SHBs erodes the personal confidence and career development of female OMS practitioners and residents. We recommend SHB educational training for all residents, faculty, and staff to ensure personal and academic growth in a safe environment.

Examining community-based pharmacist perceptions on the care of transgender patients

ObjectiveThe objective of this study was to determine whether community-based pharmacists in North Carolina have the personal confidence, comfort level, and resources needed to care appropriately for and interact with transgender patients. MethodsUsing the North Carolina Board of Pharmacy database, a link to a 25-item questionnaire was e-mailed to all actively licensed community pharmacists in North Carolina. Survey items included pharmacist demographics, prior or current education on transgender health care, comfort regarding care provision for transgender patients, and the ability to care for transgender patients at the practice site. Questionnaire items were developed in collaboration with a pharmacist who actively participates in the care of transgender patients. The questionnaire was pilot-tested among a convenience sample of student pharmacists and pharmacists for feedback on validity and question structure. The survey was open for 30 days with a reminder sent on day 15. Upon survey completion, participants had the option to be entered into a drawing to receive a gift card incentive. ResultsIn total, 342 surveys were completed of 4784 surveys distributed, yielding a 7.1% response rate. Three percent of survey respondents reported receiving education on treating transgender patients during their respective pharmacy school curricula, and 12% of respondents sought other forms of transgender education (i.e., continuing education). Seventy-one percent of respondents viewed the role of the pharmacist as important in the care of transgender patients. Sixty-six percent of respondents were comfortable welcoming transgender patients into their practice sites, and 36% were comfortable asking for pronouns. ConclusionSurvey participants reported a lack of formal or postgraduate education, which describes a need for accessible education on transgender care. North Carolina community-based pharmacists believe that it is within their role as pharmacists to provide gender-affirming care, but they may need additional training to feel comfortable in providing this care.

“I Couldn’t See a Downside”: Decision-Making About Gender-Affirming Hormone Therapy

PurposeThe aim of the article was to understand adolescents' and parents' decision-making process related to gender-affirming hormone therapy (GAHT). MethodsWe conducted qualitative semistructured interviews with transgender adolescents who began testosterone for GAHT in the prior year and the parents of such adolescents. Questions focused on decision-making roles, steps in the decision process, and factors considered in the decision. Participants used pie charts to describe the division of responsibility for the decision. All interviews were coded by at least two members of the research team with disagreements resolved through discussion. Thematic analysis was used to analyze the data. ResultsSeventeen adolescents and 13 parents were interviewed (12 dyads). The process of deciding about GAHT involves a series of small conversations, typically with the adolescent advocating to start treatment and the parent feeling hesitant. In most cases, after seeking information from the Internet, healthcare providers and personal contacts move toward acceptance and agree to start treatment. Although adolescents have some short-term concerns, such as about needles, parents’ concerns relate more to long-term risks. Ultimately, for both parents and adolescents, the benefits of treatment outweigh any concerns, and they are in agreement about the goals of personal confidence, comfort in one's body and happiness. ConclusionsTo the extent that the decision about GAHT is a medical decision, the decision process is similar to others. However, decisions about GAHT are much more about gender identity than medical risks, suggesting that interventions based in a medical framework may not aid in supporting decision-making.