Medical Mistrust Mediates the Relationship Between Nonconsensual Intersex Surgery and Healthcare Avoidance Among Intersex Adults.

IF 3.6 2区心理学 Q1 PSYCHOLOGY, MULTIDISCIPLINARY Annals of Behavioral Medicine Pub Date : 2023-11-16 DOI:10.1093/abm/kaad047

Jeremy C Wang, Katharine B Dalke, Rahul Nachnani, Arlene B Baratz, Jason D Flatt

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Abstract

Background: Intersex individuals experience poor health due, in part, to healthcare avoidance. Nonconsensual intersex surgery may contribute to medical mistrust and avoidance among intersex populations.

Purpose: The purpose of this study was to explore the relationship between nonconsensual surgery and healthcare avoidance among intersex populations and to examine if medical mistrust mediates this relationship.

Methods: Data for this cross-sectional study were collected in 2018 and analyzed in 2022. Participants completed a survey collecting information on demographics, medical mistrust, history of nonconsensual surgery, and history of postponing healthcare. One hundred nine participants with valid responses to all regression model variables were included in the study. Multivariable logistic regression models controlling for age, race, and income, examined the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. Mediation analyses of cross-sectional data examined whether medical mistrust mediated the relationship between nonconsensual surgery and postponing preventive and emergency healthcare.

Results: Mean medical mistrust score was 2.8 (range = 1-4; standard deviation = 0.8), 49.7% of participants had nonconsensual surgery in their lifetime, 45.9% postponed emergency healthcare, and 61.5% postponed preventive healthcare in their lifetime. Nonconsensual surgery was associated with increased odds of delaying preventive (adjusted odds ratio [AOR] = 4.17; confidence interval [CI] = 1.76-9.88; p = .016) and emergency healthcare (AOR = 4.26; CI = 1.71-10.59; p = .002). Medical mistrust mediated the relationship between nonconsensual surgery and delaying preventive (indirect effect = 1.78; CI = 1.16-3.67) and emergency healthcare (indirect effect = 1.66; CI = 1.04-3.30).

Conclusions: Nonconsensual surgery contributed to healthcare avoidance in this intersex population by increasing medical mistrust. To decrease healthcare avoidance, intersex health promotion interventions should restrict nonconsensual surgery and build trust through trauma-informed care.

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医疗不信任在双性成人非自愿双性手术与医疗回避之间的关系中起中介作用。

背景:阴阳人的健康状况不佳，部分原因是逃避医疗保健。未经双方同意的双性人手术可能导致双性人之间的医疗不信任和回避。目的:本研究的目的是探讨在双性人群中非自愿手术与医疗回避之间的关系，并检查医疗不信任是否介导了这种关系。方法:本横断面研究的数据于2018年收集，并于2022年进行分析。参与者完成了一项调查，收集了关于人口统计、医疗不信任、非自愿手术史和推迟医疗保健史的信息。本研究共纳入109名对所有回归模型变量均有有效反应的被试。控制年龄、种族和收入的多变量logistic回归模型检验了非自愿手术与推迟预防性和紧急医疗保健之间的关系。横断面数据的中介分析检验了医疗不信任是否介导了非自愿手术与推迟预防性和紧急医疗保健之间的关系。结果:平均医疗不信任评分为2.8分(范围= 1 ~ 4;标准差= 0.8)，49.7%的参与者在其一生中进行了非自愿手术，45.9%的参与者推迟了紧急医疗保健，61.5%的参与者推迟了预防性医疗保健。非自愿手术与延迟预防的几率增加相关(调整优势比[AOR] = 4.17;置信区间[CI] = 1.76-9.88;p = 0.016)和急救护理(AOR = 4.26;Ci = 1.71-10.59;P = .002)。医疗不信任在非自愿手术与延迟预防的关系中起中介作用(间接效应= 1.78;CI = 1.16-3.67)和紧急医疗保健(间接效应= 1.66;Ci = 1.04-3.30)。结论:非自愿性手术增加了对医疗的不信任，从而导致双性人逃避医疗保健。为了减少医疗回避，双性人健康促进干预应限制非自愿手术，并通过创伤知情护理建立信任。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Behavioral Medicine PSYCHOLOGY, MULTIDISCIPLINARY-

CiteScore

7.00

自引率

5.30%

发文量

期刊介绍： Annals of Behavioral Medicine aims to foster the exchange of knowledge derived from the disciplines involved in the field of behavioral medicine, and the integration of biological, psychosocial, and behavioral factors and principles as they relate to such areas as health promotion, disease prevention, risk factor modification, disease progression, adjustment and adaptation to physical disorders, and rehabilitation. To achieve these goals, much of the journal is devoted to the publication of original empirical articles including reports of randomized controlled trials, observational studies, or other basic and clinical investigations. Integrative reviews of the evidence for the application of behavioral interventions in health care will also be provided. .