Increasing Inclusivity and Reducing Reactance During Provider-Patient Interactions

Abstract

Background Significant health disparities exist for trans and gender-nonconforming patients, in part caused by a reduced likelihood of seeking health care due to experienced discrimination in health care settings. Increasing inclusivity in patient-provider interactions can decrease barriers to care seeking for these patients, but such advice to providers must be simple to implement and account for potential backlash among certain patient subgroups. Methods In 3 studies, we use online samples to experimentally test patient reactions to 2 methods of provider inclusivity signaling: verbal sharing of the provider’s pronouns and request for the patient’s pronouns (a method frequently suggested in the literature) and the provider wearing a pin indicating their pronouns without verbal sharing or requesting that the patient share their pronouns. Results Study 1 finds that political orientation significantly moderated the effect of pronoun request on patient satisfaction with the visit, P = .003; satisfaction with the doctor, P = .003; and willingness to return to the provider, P = .007, with politically liberal participants being more satisfied and more likely to return when pronouns were requested and politically conservative participants less satisfied and less likely to return. Study 2 replicated these findings and demonstrated that such backlash among conservative participants did not occur when inclusivity was indicated via the provider wearing a pin indicating their pronouns. Study 3 showed that while pronoun pins may be subtle enough to not cause backlash, they are noticed by the target community and increase satisfaction and willingness to return among participants who identify as trans, nonbinary, and genderqueer. Limitations These studies were hypothetical scenario studies run online rather than field studies. Conclusions These results suggest that recommendations for increasing inclusivity should account for potential negative impacts on the practice from more politically conservative patients and that more subtle methods of indicating an inclusive health care environment are likely to be more implementable for practitioners in the field while still positively affecting the target population. Highlights Increasing inclusivity in health care settings by verbally sharing and requesting pronouns can cause backlash and aggression among politically conservative patients. More subtle methods of inclusivity signaling such as providers wearing pins sharing their own pronouns do not have this type of backlash effect and increase satisfaction and willingness to return among non-cisgender patients. Recommendations for increasing inclusivity in health care settings should consider negative reactions from other patient subgroups to ensure recommendations are those providers are likely to be willing and able to implement long term.