Welcome to i²TransHealth!
Trans people living outside of metropolitan areas often have a hard time finding competent health care professionals for their transition-related needs. i²TransHealth is an e-health project aimed at improving interdisciplinary health care for trans people. It is run by the Institute for Sex Research, in close cooperation with the Interdisciplinary Transgender Health Care Center, both located at the University Medical Center Hamburg-Eppendorf (UKE) in Germany. In order to test if our concept works, we are currently conducting a randomized controlled trial (RCT). At first, i²TransHealth is available for the duration of the study only for trans people in Northern Germany who live outside the Hamburg area.
We created this interdisciplinary, internet-based tool to spread the expertise we have been able to gather over the years. Because we believe that trans people should have the chance to benefit from it, no matter how close they live to Hamburg. Our i²TransHealth online platform allows biweekly video consultations as well as messaging between the participants and mental health care professionals.
A network of collaborating medical health care providers across Northern Germany ensures that our participants also have access to local health services. So if they need some urgent support or have concerns not directly related to being trans, they have a health professional close by who is willing to provide trans-sensitive care. This way, we are hoping to enhance health care for trans people in rural areas and raise awareness for trans issues within the medical community.
Interdisciplinary, internet-based Trans Health Care (i²TransHealth): A Randomized Controlled Trial
Abstract
Background. Living in an area with no or deficient structures for transgender health is disadvantageous for the people concerned. Among others, structural inequality might lead to high treatment dissatisfaction as well as increases in distress, development of mental disorders, and absences from work.
Aims. As a health services research project, i²TransHealth aims at reducing the structural disadvantage for trans persons living in areas lacking specialized transition-related health care. In addition, the i²TransHealth network aims to increase the trans-related expertise of the collaborating non-specialized health professionals.
Methods. Located at the Institute for Sex Research and in cooperation with the Interdisciplinary Transgender Health Care Center Hamburg (ITHCCH), both University Medical Center Hamburg-Eppendorf (UKE), Germany, i²TransHealth is a randomized controlled trial that investigates the outcomes of a internet-based health care approach for trans persons. i²TransHealth is an innovative intervention including video consultations and a 1:1 chat with mental health professionals. By cooperating with the ITHCCH, general physicians (GPs) and psychiatrists provide first and local access to the specialized trans health care approach provided by the UKE.
After completing an initial assessment in person at the UKE, study participants are randomly assigned to either the intervention or control (waitlist) group. In the intervention group, participants are invited to use the i²TransHealth online platform for four months. This includes biweekly video consultations with the mental health professionals and a messaging tool for communication in-between the video calls. In addition, participants can access health care by licensed GPs and psychiatrists near their place of residence if needed (especially in case of a somatic or psychosocial crisis). Participants allocated to the control group will be able to proceed with their transition-related care after four months of study participation, either via the i²TransHealth e-health approach or via standard care procedures. Both groups can continue the treatment after completion of the study, either via i²TransHealth or as part of standard care.
Outcomes. The primary outcome measure is the presence and intensity of psychosomatic symptoms as assessed by the BSI-18. Secondary outcome measures include quality of life (WHOQOL-BREF) and patient satisfaction (ZUF-8). Additionally, the health care-related costs and cost-effectiveness of the i²TransHealth model will be assessed using the CSSRI and EQ-5D-5L. Lastly, it will be measured whether being part of the i²TransHealth network helps to increase the trans-related expertise of the collaborating medical practitioners.
Expected results. As for the primary outcome, we anticipate a reduction of symptoms in the intervention group. With regard to the secondary outcome parameters, in the intervention group an increase in both quality of life and patient satisfaction is expected. Finally, both cost-effectiveness and trans-related expertise of the collaborating health professionals should be improved.
Conclusion. Subject to a positive RCT-based evaluation of i²TransHealth, the project is to be consolidated in order to compensate for the structural disadvantages of rural regions in terms of trans health care and thus improve the treatment options for trans people.
Timo O. Nieder tnieder[AT]uke[PUNKT]de
Co-PI: Arne Dekker, Peer Briken
Please click here to read the study protocol.