Guys Get Pap Tests Too: Developing Cervical Cancer Screening Outreach Materials for Female-to-Male Transgender Patients Ida M. 1,2 Bernstein , Sarah M. 3 Peitzmeier , Sari L. 2,4 Reisner , Jennifer E. Potter 1,5,6 1 Harvard Medical School, 2 The Fenway Institute, Fenway Health, Boston, MA, 3 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 4 Department of Epidemiology, Harvard School of Public Health, 5 Beth Israel Deaconess Medical Center, 6 Fenway Health, Boston, MA Background Results • It is recommended that FTM patients with a cervix follow the same cervical cancer screening guidelines as non-trans women1 Participant Demographics • Unique barriers to screening for trans men exist2 • Fenway Health FTM patients are less likely to be up to date on Paps and 10 times more likely to have inadequate Paps than nontrans women3 • Targeted interventions are needed to improve Pap utilization among trans men Aims • Understand trans mens’ attitudes towards and barriers to cervical cancer screening • Develop novel cervical cancer screening outreach materials for FTM patients Methods RECRUITMENT  Social media, FH website, community listservs  21+ years, born with a cervix, self-identified on FTM spectrum IN-DEPTH INTERVIEWS + ONLINE LimeSurvey® SURVEY  Explored participant experiences with Pap tests and preferences for outreach campaign DEVELOPMENT OF BROCHURE  Interviewer field notes and online survey responses incorporated into text and images  Data compared to existing community-driven education materials4,5  Brochure reviewed by team of patient outreach and transgender healthcare specialists • 32 in-depth interviews • Mean age 33.3 (SD=10.6) • 18.8% racial/ethnic minority • 65 completed online survey responses • Mean age 33.4 (SD=8.98) • 13.8% racial/ethnic minority Key Themes Used in Brochure Text Design THEME “Have a dialogue with me about what I need. Every trans person is different, so each of us may need support in different ways.” “Avoid language that feminizes the process and make it more of a healthy medical thing that has to be done to keep you safe and doesn’t reflect your gender.” “We need these exams, but a bad experience with one provider can limit the likelihood of returning to care and opening ourselves up for that type of vulnerability again.” Patients and providers should jointly customize Pap tests to fit individual needs and comfort Need for gender-affirming communication of Pap and associated health information Feeling in control and confidence in provider competency in trans healthcare are priorities for FTM patients APPLICATION TO DESIGN Provide options: • Bring support person • Ask for chaperone • Keep shirt on • Pediatric speculum • Topical anesthetic • Avoid: • Gendered language e.g. Pap as Women’s or Reproductive Health • Unnecessary use of female anatomical terms Focus on: • Gender neutral language e.g. Pap as cancer prevention • Masculine identity • Professional language • • Water-based lubricant Adjust interactions during exam Consider low-dose anxiety med, etc. Emphasize: • Provider has experience in trans healthcare • Patient strategies for exercising control of exam Participant Feedback Informed the Selection of Images • Desire for representation of diversity of FTM community (age, gender expression, race/ethnicity, etc.) • Recommended exclusion of images of women, medical equipment, and anatomical diagrams Conclusions References • Participant feedback reflects unique barriers to adequate cervical cancer screening faced by the FTM community 1 American College of Obstetricians and Gynecologists. Committee opinion: Healthcare for transgender individuals. 2011;512. • Spectrum of comfort with Paps suggests communicating customization options for the exam may be an effective outreach tool 2 Feldman J. Medical and surgical management of the transgender patient: What the primary care clinician needs to know. In: Makadon H, Mayer K, Potter J, Goldhammer H, eds. Fenway guide to lesbian, gay, bisexual, and transgender health. 2008;365-392. 3 Peitzmeier SM, Reisner S, Harigopal P, Potter J. Female-to-male patients have high rates of unsatisfactory Paps compared to non-transgender females: Implications for cervical cancer screening. Manuscript submitted for publication. In press. • Our brochure will be further evaluated by community member focus groups to ensure effective tailoring to the needs of FTM individuals 4 The Brown Boi Project. Freeing ourselves: A Guide to Health and Self-Love for Brown Bois. 2011 “Educate yourself and treat us like the humans we are. This is a hard road we are traveling and something vital like healthcare shouldn’t be such an obstacle for us.“ Acknowledgments 5 Sherbourne Health Center. Check it out guys. 2010. Accessed on Dec 12 2013. Many thanks to the Scholars in Medicine Office, the Center for Primary Care, and The Open Gate Foundation