Health Communication

     The transgender identity, experience, and community in the United States has undergone a substantial evolution since the Stonewall Uprising in 1969. The word “transgender” has evolved to incorporate a multitude of identities, creating a constellation of lived experiences—each one varied and rich. There are now Transgender Studies programs in higher education. Transgender literature and media are part of mainstream pop culture. The general public possesses an increased knowledge of transgender individuals and their experiences. According to a Pew Research Center study of U.S. adults in June 2021, “about four-in-ten Americans (42%) say they personally know someone who is transgender, up 5 percentage points since 2017” (Minkin and Brown, 2021). Over time, health communicators contributed to the publication of materials and campaigns specifically targeted towards transgender individuals, their allies, and the general population. One such campaign is “Ready, Set, PrEP!” (RSP). Developed by the U.S. Department of Health and Human Services and launched on World AIDS Day in 2020, the RSP campaign embodies a modern take on transgender-inclusive health campaigns. The foundation of RSP is its compelling narrative messaging and the incorporation of succinct yet profound storytelling. By continuing to create affirming narratives with compelling storytelling, health communicators contribute to the delivery of more effective, inclusive, and positive healthcare experiences for transgender adults. 

    

     The groundbreaking efforts of the National Center for Transgender Equality (NCTE) in 2015 yielded a wealth of statistics that show—on a large, quantitative scale—the wide-ranging experiences of transgender individuals across the United States. Known as the U.S. Trans Survey (USTS), the NCTE collected responses from almost 28,000 transgender individuals. Although now six years old, the USTS remains the gold standard for quantitative data about transgender individuals and their lived experiences

in the United States. The statistics within the USTS point out a number of red flags for any professional within the healthcare industry, including: 

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“Respondents also encountered high levels of mistreatment when seeking health care. In the year prior to completing the survey, one-third (33%) of those who saw a health care provider had at least one negative experience related to being transgender, such as being verbally harassed or refused treatment because of their gender identity. Additionally, nearly one-quarter (23%) of respondents reported that they did not seek the health care they needed in the year prior to completing the survey due to fear of being mistreated as a transgender person, and 33% did not go to a health care provider when needed because they could not afford it” (NCTE, 2015, p. 3). 

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Researchers and public health professionals continue to pull from this dataset, as exemplified by Kcomt et al. (2020) in their research for Healthcare Avoidance due to Anticipated Discrimination Among Transgender People. Their study is a secondary analysis of USTS data, led by the following research question: “Is there an association between gender identity/expression and healthcare avoidance due to anticipated discrimination?” (Kcomt et al., 2020, p. 2). This secondary analysis sample was limited “to persons aged 25 to 64” and its authors acknowledge that: “The USTS contained a disproportionate number of white, young, and highly educated respondents” (Kcomt et al., 2020, p. 3). Results from this secondary analysis serve as valuable information to professionals creating a health campaign, especially in segmenting an audience as broad as the transgender community. The study found “a disproportionate prevalence of healthcare avoidance among transgender men relative to other gender identity/expression subgroups” and “transgender individuals who were somewhat visually conforming or visually non-conforming had increased odds of avoiding healthcare due to anticipated discrimination” (Kcomt et al., 2020, pp. 5-6). Combined with the data from the USTS, studies like the one done by Kcomt et al. (2020) highlight the continued need for affirming, inclusive, and accessible healthcare for transgender adults in the United States. Health campaigns that use narratives and storytelling like RSP set the stage for informative engagement and long-lasting change to the larger universe of equitable healthcare. 

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     The incorporation of narratives in messaging is an asset to any health campaign, as “A recent meta-analysis of narrative research shows that stories have statistically significant relationships with people’s beliefs, attitudes, intentions, and behaviors’” (Braddock and Dillard, 2016, as cited in Du Pré and Overton, 2020, p. 337). Building an effective narrative requires a framework for the message. In their 2019 article, Reducing Health-Related Stigma Through Narrative Messages, Heley et al. work off of this framework: “‘a representation of connected events and characters that has an identifiable structure, is bounded in space and time, and contains implicit or explicit messages about the topic being addressed’” (Kreuter et al. 2017, p. 222, as cited in Heley et al., 2019, p. 850). The RSP campaign finely tuned their video storytelling into one minute shorts, with clear characters and purpose. Through the videos presented by Shareef and Toni, nonbinary and transfeminine individuals respectively, RSP models the incorporation of rich, yet concise, narrative storytelling for a targeted audience. Their stories use “I” statements to make it personal, yet they each speak on topics many transgender individuals find relatable. In their article, Storytelling/Narrative Theory to Address Health Communication with Minority Populations, Lee et al. detail three types of storytelling for health communicators to select from: 

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“(1) personal narratives—stories that contain accounts of significant incidents in one’s life; (2) historical documentary—stories about dramatic events that help people to understand the past, and (3) stories designed to inform or change the audience/listener’s attitudes about a particular concept or behavior” (Robin, 2006, as cited in Lee et al., 2016, p. 58).

  

Any of the three types are highly customizable and adaptable to any budget. In addition, instead of hiring celebrities to depict any of these three types of storytelling, health communicators can hire directly from their targeted community. Celebrity spokespersons are often costly and may even inspire the effect of source homophily (Rogers, 1973, as cited in Du Pré and Overton, 2020, p. 331). Hiring community members like Shareef and Toni creates an opportunity to build trust with health communicators and the health profession at large. Effective health communication relies on collaboration, not just between providers and patients, but between health communicators and their audiences. By working with their audience, health communicators can tailor their narratives and storytelling to deliver a message with a high degree of credibility and specificity. The opportunities to create campaigns and inspire target audiences into meaningful action are endless with the use of narrative messaging.