Gender is a concept with many facets. Everyone has a gender expression. Can learning about gender expression help healthcare professionals provide better and more effective treatment plans for the LGBTQ+ community?
Gender Expression
Gender expression refers to the ways that individuals present their gender identity and themselves. This can be clothing, haircuts, behaviors, etc. For many, there can be confusion between what society expects from their gender and how these individuals choose to present themselves. Gender expression is constructed from the culture that surrounds it, meaning that there may be a shared social expectation about gender. It can also mean that the same feminine hair or clothing style in one setting could be seen as masculine in another.
Society tries to regulate expression by making women wear certain kinds of clothes, and men other kinds, in order to participate in school, work, and when in public.
When cultures enforce gender norms it is known as gender policing, which can range from dress codes to physical and emotional punishment.
Creating a safe space for all genders requires awareness of these explicit or implicit gender norms so policing can be prevented. (José A Bauermeister, et al., 2017)
Research has shown that there are increased rates of discrimination against transgender and gender-nonconforming individuals compared with bias against those who are LGBTQ. (Elizabeth Kiebel, et al., 2020)
Health Care
Gender expression can and does affect access to and quality of health care.
Individuals with a gender expression that is different from what is expected for their assigned sex at birth may experience increased bias and harassment from providers. (Human Rights Watch. 2018)
A significant percentage of patients feared health workers would treat them differently because of their expression. (Cemile Hurrem Balik Ayhan et al., 2020)
Minority stress has been shown to play an important role in health imbalances. (I H Meyer. 1995)
Research suggests that gender expression is a part of the minority stress described by cisgender sexual minorities and gender minorities. (Puckett JA, et al., 2016)
Better Training
The effects of gender expression are different depending on a person’s sex, gender identity, and their setting.
However, doctors do need to know a person’s sex that was assigned at birth to be able to do proper screening tests, like screening for prostate or cervical cancer.
One way to be more affirming is for the doctor to introduce themselves first, using their own pronouns.
Health workers should ask everyone what name they prefer to be called and what pronouns they use.
This simple act invites the patient to share without creating awkward uneasiness.
Each person chooses how to present themselves to the world, and we respect all. We at Injury Medical Chiropractic and Functional Medicine Clinic will work to address the effects of minority stress on health disparities and raise awareness of the ways to continually improve positive experiences for LGTBQ+ individuals seeking inclusive health care for neuromusculoskeletal injuries, conditions, fitness, nutritional, and functional health.
Revolutionizing Healthcare
References
Bauermeister, J. A., Connochie, D., Jadwin-Cakmak, L., & Meanley, S. (2017). Gender Policing During Childhood and the Psychological Well-Being of Young Adult Sexual Minority Men in the United States. American journal of men’s health, 11(3), 693–701. https://doi.org/10.1177/1557988316680938
Kiebel, E., Bosson, J. K., & Caswell, T. A. (2020). Essentialist Beliefs and Sexual Prejudice Toward Feminine Gay Men. Journal of homosexuality, 67(8), 1097–1117. https://doi.org/10.1080/00918369.2019.1603492
Human Rights Watch. “You Don’t Want Second Best”—Anti-LGBT Discrimination in US Health Care.
Ayhan, C. H. B., Bilgin, H., Uluman, O. T., Sukut, O., Yilmaz, S., & Buzlu, S. (2020). A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings. International journal of health services: planning, administration, evaluation, 50(1), 44–61. https://doi.org/10.1177/0020731419885093
Meyer I. H. (1995). Minority stress and mental health in gay men. Journal of health and social behavior, 36(1), 38–56.
Puckett, J. A., Maroney, M. R., Levitt, H. M., & Horne, S. G. (2016). Relations between gender expression, minority stress, and mental health in cisgender sexual minority women and men. Psychology of Sexual Orientation and Gender Diversity, 3(4), 489–498. https://doi.org/10.1037/sgd0000201
In today’s busy world individuals need a little help when it comes to letting go of bad/negative behaviors and adopting/embracing positive behaviors to sustain optimal health and lifestyle. This is where a health coach�comes in.
More adults in the United States have a chronic disease and around thirty percent have two or more.
Many healthcare professionals do not know how to counsel patients on healthy living and, if they do, the information is limited to very basic knowledge like exercise and eat healthily. With this type of info and not a lot of enthusiasm, patients are not going to listen or make lasting changes.
Many providers do not listen to what’s going on and just tell patients what to do, instead of discussing the best options they have for their health. People being told what to do are not likely to listen or act upon the recommendations.
A health coach creates a custom getting healthy plan with you that fits your life, gets you going, sets up a strategy for the challenges and sees you through! This is what a health coach does.
Health coaching Involves
Communication
Motivation
Continued Support
This allows individuals to make meaningful behavior changes that will last forever.
Coaching centers on:
Thorough conversation
Listening
Clinical Intervention
Strategies
These are aimed to actively engage patients in positive behavior change.
Health coaches take on patients wherever they are in their health. An individual can be healthy and just want some advice to individuals that are extremely unhealthy with weight issues, chronic illness, disease or all of the above.
The point is to help individuals learn self-management techniques. The coach teaches, motivates and strategizes with the individual to make educated/informed decisions that will turn into regular healthy habits.
Coaching comes in the form of:
Setting�goals that are achievable�
A Patient’s Values
Strengths
Motivation
Encouraging the patient
This is how healthy attitudes and behaviors are developed.
The Health Journey Begins
The patient’s health history is taken into account. Then the coach asks:
Where they want to be in their health
What Values they hold close
What Goals they have in mind
The plan is Created
Progress is Tracked
Challenges are met
The long-term plan is Created
Patients oftentimes do not know where they are from a health perspective and might not be sure how to explain. This is where health coaches and their training can breakdown any questions/issues a patient may have.
A health coach will look at where a patient is healthwise based on:
Emotional factors
Environmental factors
Financial factors
Psychological factors
Physical factors
Recreational factors
Spiritual factors
Social factors
This health inventory is for the patient to reflect on where they are in their health and where they want to be.
Patients are welcome and encouraged to ask questions about the plan, make changes, reset goals, etc.
Motivating the Patient
Motivation can come in various forms. As people learn in various ways, so too are the motivational strategies to get patients to exercise the positive behavior outlined in their treatment plan. Some ways coaches motivate are:
They collaborate with patients and don’t approach the plan with an all-knowing mindset.
Understand the motivation of the individual to change.
Motivational Principles:
Empathy
Discrepancy
Support patient’s ability
Six stages of behavioral change:
Precontemplation – Patients do not see any problems and do not consider their behavior as negative, and do not see the problems their behavior is causing.
Contemplation – Patients start to think about healthy behaviors.
Preparation/Determination�– Patients are ready to take action toward behavior change and believe the new behavior will lead to a healthy life.
Action�– Change begins and the intention is to keep going.
Maintenance – Behavior change has been for more than six months and continuing on the right track.
Termination�– Negative behaviors are eliminated.
There are different strategies to get through each stage and on to the next until the positive behavior is achieved.
Helping the patient find the coaching plan that is right for them.
Patients are helped by figuring out what they want to change about their health based on what they see and
the most important changes for them. There is no correct answer, as it is different for everyone.
Understanding Your Values
Coaches encourage the patient to identify their values, and what is most important for each individual.
These include:
Family
Friendship
Health
Love
Values begin early in childhood and become reevaluated as life goes on, and can change.
Clarity is important to help the patient build self-awareness to make intelligent decisions and staying balanced.
A coach might ask questions like:
What made you choose the unhealthy product versus the healthy version?
How much stress do you think you have to deal with on a daily basis?
Do you make time for yourself?
For some, identifying negative behavior can help, as the patient grows and realizes how their health is changing, their values start to change.
This information helps to create a plan of action along with steps to help the patient’s decision making.
While working with the patient to determine goals and create steps, tools and methods are created help to ensure the patient understands their role in getting healthy.
Asking Questions
Coaches ask patients what they know and what they would like to know?�There are no incorrect questions, aks away, as the more an individual knows, as well as the more that the coach knows about the patient, the better the treatment plan will be.
Teaching
If the patient doesn�t understand, the process is repeated until the patient is able to explain the treatment plan back to the coach so everything is clear.
This technique is recognized by various associations, including the:
American Academy of Family Physicians
American Hospital Association
Primary Areas of Improvement
Before setting goals the patients go over the primary areas of their life that they want to improve/change.
These primary areas may be very similar to the patient�s values.
Examples include:
Health
Family
Career
Finances
Recreation
Social Relationships
Once a patient has identified what they would like to focus on, brainstorming sessions are put into action, as to what they want to change or improve for each primary area.
They are then broken down into smaller goals in the creation of the main plan of action.
As the patient moves forward they are more motivated and encouraged to take on bigger challenges.
Couple making a healthy smoothie
Goals
Patients understand what areas of their life they want to improve/change.
With the primary areas known, the patient begins the challenge of changing their current unhealthy status to healthy.
Areas to consider:
What exactly do I want to achieve?
How will I achieve this goal?
Timeframe to achieve this goal?
Why is this goal important to me?
Where to go to next once the goal is achieved?
SMART Goals
When the patient is ready, the coach will assist in developing:
Specific
Measurable
Attainable
Relevant
Timely
SMART goals that allow for structure and trackability and create clear milestones for the individual.
Planning
Once a health coach understands where the patient wants to go, the next phase is planning.
Patients help in creating their treatment plan.
This plan is an agreement between the patient and the health coach that describes the behavior change that the patient wants to make, how they’re going to go about it, and their commitment to the final result.
Example of goals a patient will follow to lose weight:
Try new fruits and vegetables
Find creative ways to incorporate exercise at work.
Stay hydrated by keeping a water bottle and refilling it every two hours.
Cooking healthy meals at first twice a week then three times and so on.
Walking after meals.
These small tasks make it easier for the patient to see their progress.
The coach will check with the patient regularly to make sure they are sticking to the plan.
Health Coach
Goal Progress
Health coaches can ensure a patient has consistent motivational support by creating a follow-up plan that works in conjunction with their primary treatment plan.
Follow-up care may include schedules for physical exams or tests, referrals, and recommendations to keep positive behavior development.
Coaches and patients work together to create realistic goals for the future.
As the patient progresses, the health coach may make additional recommendations or work with the patient to adjust their plan or making sure the patient knows where to turn to if they have questions.
Continued Support
Once goals are being achieved it is important to have support to continue the positive behavior. Traditional sources of support include:
Family
Friends
Colleagues
Community
Patients may not always have access to external support, coaches also teach the patients how to find positive support in various activities around town that can help patients and their overall health.
At Injury Medical Chiropractic & Functional Wellness clinic we have the best-rated team of health practitioners to get you to your best optimal health.
*Detox Your Body* | Detox Doctor | El Paso, TX (2019)
Fred Foreman is a basketball coach who depends on his overall health and wellness to be able to engage in his everyday responsibilities. As a result, coach Foreman started the 6 Day Detox Program, designed to help renew and enhance the human body’s cleansing and detoxification capabilities.
NCBI Resources
Good health is built on diet and exercise. The goal is to continually improve by maintaining healthy habits that develop more healthy behaviors. You do not have to do anything drastic. You will have an easier time making changes if you start small and gradually shift towards a lifestyle that is best for you. A health coach can get you operating and performing at the highest level!
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
