Gender-Affirming Care Is Not Standard Care in Occupational Therapy: A Scoping Review
Bibliographic record
Abstract
IMPORTANCE: The transgender and gender-diverse (TGD) community faces significant health care disparities, including elevated rates of mental health issues, poverty, and barriers to accessing affirming care. Occupational therapy practitioners are ethically obligated to provide gender-affirming care, yet there are no practice guidelines for such care. OBJECTIVE: To examine the landscape of gender-affirming care within occupational therapy practice, aiming to identify gaps for future research and guidelines. DATA SOURCES: Six databases (MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, Web of Science). Search dates ranged from database inception to September 19, 2023. STUDY SELECTION AND DATA COLLECTION: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidelines for all methodologies. Studies were included if they described gender-affirming care, included language related to the transgender and gender-diverse community, and mentioned occupational therapy. Studies were excluded if they were not peer-reviewed or did not include an intervention. FINDINGS: A total of 614 studies were identified, and 17 were included. Of the included studies, the majority were qualitative (n = 9) and from the United States or Canada. Published research highlighted clinicians' need for more training in gender-affirming care and suggested diverse modalities to bridge gaps in working with TGD individuals. CONCLUSIONS AND RELEVANCE: This review underscores the urgent need for targeted research to address TGD individuals' specific needs in occupational therapy practice. Future efforts should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy. Plain-Language Summary: The transgender and gender-diverse (TGD) community often encounters obstacles in accessing health care, including mental health issues and barriers to affirming care. Occupational therapy practitioners play a crucial role in providing gender-affirming care, yet there is a lack of clear guidelines for doing so. This study aimed to examine the current state of gender-affirming care in occupational therapy and identify areas for improvement, ultimately benefiting both practitioners and clients. Future research should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy. Positionality Statement: The authorship team represents one individual who identifies as nonbinary and four who identify as cisgender. Most of the authors identify as White. Three authors identify as LGBTQ+. Two authors have prior experience writing scoping reviews.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.059 | 0.218 |
| Meta-epidemiology (narrow) | 0.001 | 0.002 |
| Meta-epidemiology (broad) | 0.007 | 0.006 |
| Bibliometrics | 0.013 | 0.017 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.009 | 0.011 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".