A pre/post study of a narrative “IDEAS” intervention’s impact on provider stigma and feasibility of collecting transgender and gender diverse veteran care experiences

Abstract

Background: Transgender and gender diverse (TGD) Veterans face significant health disparities, including greater psychiatric comorbidities and suicide attempts than the general Veteran population, which are often exacerbated by provider stigma. Innovations targeting provider stigma are warranted to address this healthcare concern. IDEAS is a film-based intervention for reducing provider stigma to improve healthcare for TGD Veterans. Methods: We used a hybrid type 2 design to examine IDEAS implementation acceptability, feasibility, and effectiveness (decreased provider stigma). We also tested the feasibility of a nested data collection methodology that would allow future studies to assess whether IDEAS implementation with providers impacted care from TGD patients’ perspectives. The study involved primary care and mental health providers from a Midwestern VA Medical Center and TGD Veterans with appointments within six months before and after IDEAS. 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 pre and post IDEAS. AIM and FIM scores were averaged across providers and paired two samples t tests were used to determine change in provider stigma. TGD Veteran recruitment and response rates were tracked, and pre/post survey scores were averaged to illustrate trends in pre/post score differences. Results: Average AIM and FIM scores were above 4 on a scale of 1 (‘highly disagree’) to 5 (‘highly agree’), suggesting providers ‘agree’ that the IDEAS intervention was acceptable and feasible. Provider stigma measured by the AAQ-S decreased significantly post-intervention (p < 0.01). Feasibility benchmarks for testing a nested data collection design to obtain information on TGD Veteran healthcare experiences pre/post IDEAS were met. Preliminary exploration of the sum/difference of average pre versus posttest item scores of Veteran data suggested improved perceptions of provider communication, trust. Conclusions: IDEAS shows promise in reducing provider stigma and enhancing 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. Supplementary Information: The online version contains supplementary material available at 10.1186/s12889-025-24494-2.