A pre/post quasi-experimental study of provider stigma and Veteran experiences surrounding a narrative “IDEAS” intervention to promote positive clinical encounters

Background : Transgender and gender diverse (TGD) Veterans face significant health disparities, often exacerbated by provider stigma. The US Department of Veterans Affairs (VA) prioritizes research to improve care for TGD Veterans. This study evaluates the feasibility and acceptability of the IDEAS - a film-based intervention designed to reduce provider stigma and improve clinical encounters for TGD Veterans. Methods : A pre/post quasi-experimental design was used to assess the impact of the IDEAS intervention on provider stigma and TGD Veteran experiences. The study involved primary care and mental health providers from a Midwestern VA Medical Center and TGD Veterans who had appointments within six months before and after the intervention. Providers completed the Acceptability of Intervention Measure (AIM) and Feasibility of Intervention Measure (FIM) post-IDEAS, and the Acceptance and Action Questionnaire – Stigma (AAQ-S) pre and post-intervention. TGD Veterans completed the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Item Set (CAHPS-CC) and an author-created survey. Results : The IDEAS intervention was found to be both acceptable and feasible, with average AIM and FIM scores above 4. Provider stigma, as measured by the AAQ-S, decreased significantly post-intervention (p<0.01). TGD Veterans reported improved perceptions of provider cultural competence and affirming care post-intervention, with notable improvements in communication, trust, and respect. Conclusions : The IDEAS intervention shows promise in reducing provider stigma and enhancing the healthcare experiences of TGD Veterans. Further research is needed to explore the long-term impact of such interventions on TGD Veteran health outcomes and to refine assessment tools for capturing nuanced patient experiences.