All ETDs from UAB

Advisory Committee Chair

Retta R Evans

Advisory Committee Members

Hussain D Abdullatif

Michelle R Brown

Tekuila R Carter

Jenna M Lachenaye

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Education


Purpose: Transgender patients face healthcare discrimination, resulting in a delay or avoidance in seeking care and increased negative health outcomes. The presence of cultural competence in patient-provider interactions has been shown to increase trust and satisfaction, resulting in better health outcomes. However, physicians receive little to no training on how to interact with transgender patients in a culturally competent manner. Anesthesia physicians often have no prior relationship with their patients and have very limited time for patient interaction before delivering care. This is why it is essential that anesthesia physicians possess the knowledge and skills to treat all types of patients in a confident, culturally competent manner, including those identifying as transgender. The purpose of this study is to determine the behavioral factors that influence the provision of culturally competent care by anesthesia physicians to transgender patients. Methods: A two-phase design was utilized to explore the attitudes, subjective norms, and perceived behavioral control of anesthesia physicians, both in training and practicing independently. The first study phase allowed exploration of themes related to the facilitators and barriers of the provision of culturally competent care to transgender patients. The second phase involved the creation of a survey informed by findings in the first phase. Analysis/Results: Thematic analysis was performed on results from an elicitation survey utilized in the first phase of research. In the second phase, the 51-question survey was distributed to 100 anesthesia physicians at a single academic medical center within the southeastern U.S. Seventy surveys were returned, resulting in a 70% response rate. Analyses were conducted to determine the largest influence of intent to interact with transgender patients in a culturally competent manner, as well as to establish the reliability of the tool. Conclusions: Attitude toward the target behavior was shown to be the largest influencer of intent to interact with transgender patients in a culturally competent manner. Subjective norms were also shown to be significantly influential. Determining the significant influencers of intent can inform future research and interventions aimed at increasing the target behavior. Keywords: transgender, theory of planned behavior, anesthesia, physician, cultural competence

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